Adult

HIV PEP and PEPSE: post exposure prophylaxis

  • PEP = Post-exposure prophylaxis (usually occupational exposure, e.g. needle stick injury)
  • PEPSE = Post-exposure prophylaxis following sexual exposure.

PEP and PEPSE

  • Cases should be risk assessed on an individual basis taking into account nature of exposure and the source.
  • Sexual exposures should be referred to the Sexual Health clinic during their opening hours (9am -5pm Monday-Friday or 9am-11am Saturday)
  • Are only given after discussion with an Infectious Diseases consultant or SpR
  • Should be started as soon as possible after exposure. Ideally within 24hours (but up to 72hours is indicated)

TTO packs (for 28 days of treatment) are available from:

  • Pharmacy (JR, Churchill and Horton)
  • Oxford and Banbury Sexual Health Departments
  • Emergency Drug Cupboards at the JR, Churchill and Horton (for out of hours use only – contact on-call Pharmacist via switchboard to access).

Anyone presenting for PEP or PEPSE more than 72 hours after exposure should be referred to occupational health (COHWB) or Sexual health respectively as a non-emergency.

Preferred

Tenofovir disoproxil  245mg + emtricitabine 200mg 1 tablet po od

AND

Raltegravir 1200mg po od (2x 600mg tablets only, do not use the 400mg tablets) 

Duration: 28 days

 

To prescribe use ED PEP/PEPSE PowerPlan.

Note: PEP/PEPSE TTO packs only should be used. These contain 30 days supply and patients are advised to discard the unused tablets.

Alternative

If the source of infection is known or believed to have a resistant virus, or if the first line drugs are not appropriate (e.g. in renal impairment), alternative drugs may be prescribed. The decision for using alternative drugs should be undertaken by an HIV specialist.

Advice given to the patient

  • Take the first dose immediately and complete the course (28 days).
  • Ensure they understand how to take the tablets (i.e. dose, frequency, duration).
  • Ensure there are no interacting medications. Advise patients not to take any indigestion remedies, calcium or iron supplements less than 4 hours before or after raltegravir.
  • Advise the patient about potential side effects.
  • Inform them of the details for follow-up and emphasise the importance of attending follow-up appointments.

Further advice

PEP Supplies & Follow up

During normal working hours cases potentially requiring PEP will be dealt with through the Micro/ID SpR, or the occupational health department for members of staff.

Out-of-hours, for any occupational exposures or potential PEP cases, the on-call Micro/ID SpR should be contacted to arrange assessment.        

Follow up should be arranged in an Infectious Diseases clinic or as a day attender at the John Warin ward or Rowan Day unit as soon as possible.

 

PEPSE Supplies & Follow up

During working hours (Monday to Friday 9am-6pm, Saturday 9am-12pm), cases potentially requiring PEPSE are assessed by Oxford Sexual Health Service who will issue a prescription for PEPSE which the patient collects from pharmacy.

Out-of-hours, potential PEPSE cases should be referred to the nearest emergency department (ED) where the required triage paperwork should be completed to assess whether PEPSE is required.  See ‘Guidelines for the out of hour’s assessment of need and supply of Post-Exposure Prophylaxis following Sexual Exposure (PEPSE)’

Follow up should be arranged with Oxford Sexual Health Service as soon as possible.

Contact details for the sexual health clinics:

Editorial Information

Last reviewed: 01 Sept 2022