Practice Guidelines

CDC Releases Updated Guidelines for Postexposure Prophylaxis After Sexual, Injection Drug, or Other Nonoccupational Exposures to HIV

 


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Am Fam Physician. 2016 Sep 1;94(5):392-393.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• Evaluate exposures promptly and initiate nPEP as soon as possible after exposure.

• Do not delay nPEP pending HIV test results or source person risk factor assessment.

• Prescribe three-drug nPEP regimens.

• Test for other sexually transmitted infections.

• Offer PrEP to those who continue to be at risk.

From the AFP Editors

Postexposure prophylaxis (PEP) with anti-retroviral drugs to prevent transmission of human immunodeficiency virus (HIV) following sexual or injection drug use exposures (nonoccupational PEP or nPEP) is an essential intervention requiring a timely response. Updated guidelines from the Centers for Disease Control and Prevention (CDC) provide clinicians with guidance on assessing and managing exposures, new nPEP regimens, schedules for baseline and follow-up testing for HIV and associated infections, and longer-term prevention measures including preexposure prophylaxis (PrEP).

Indications for nPEP

Indications for nPEP remain unchanged. The patient must be exposed to a potentially infectious fluid, including semen, vaginal or rectal secretions, and blood or any body fluid contaminated with blood. Non-bloody saliva, urine, feces, vomitus, sputum, nasal secretions, sweat, and tears are not infectious for HIV. There should be knowledge or reasonable suspicion that the source person is infected with HIV. With sex partners and injection drug use, it might not be possible to obtain accurate information on the source person's HIV status. The patient needs to come into contact with a mucous membrane (e.g., vagina, rectum, mouth) for sexual exposures or through the skin for injection drug exposures. And finally, exposure needs to have occurred within the previous 72 hours.

Baseline Testing

Exposed persons should have HIV testing, preferably using a rapid antibody or rapid antigen-antibody test, to rule out infection from a previous exposure. Exposed persons with HIV infection are not candidates for nPEP and need further evaluation for treatment. If HIV test results will not be available during the initial evaluation, a decision whether nPEP is indicated should be made without delay, based on the assumption that the exposed person is not

Address correspondence to Ronald H. Goldschmidt, MD, at Ronald.Goldschmidt@ucsf.edu. Reprints are not available from the author.

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of Practice Guidelines published in AFP is available at http://www.aafp.org/afp/practguide.



 

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