Synopsis
Assess HIV exposure urgently, start and complete indicated 28-day PEP within the effective window, and deliver PrEP with reliable HIV, renal, hepatitis B and STI monitoring.
- PEP is an emergency: start ideally within 24 hours and no later than 72 hours after a substantial exposure.
- Assess fluid, route, mucosal or percutaneous injury, source viral load and treatment, prevalence and modifying factors without using stigmatizing identity assumptions.
- Take baseline fourth-generation HIV, renal, liver, hepatitis B and C, pregnancy and STI tests, but do not delay the first PEP dose.
Key red flags
Exposure approaching 72 hours needs immediate prescribing rather than referral delay.
Condomless receptive anal or vaginal exposure to a source with transmissible HIV may warrant PEP according to viral load and context.
Investigation priorities
Exclude established infection before PEP or PrEP and provide a comparison for follow-up.
Management branches
A substantial exposure occurred within the preceding 72 hours.
- Establish exact time, fluid, route, injury, source HIV status and viral suppression and whether the exposure was consensual.
- Take baseline HIV, renal, liver, hepatitis, pregnancy and site-specific STI specimens without delaying the first dose.
Key medicines
Tenofovir disoproxil and emtricitabine for PEPGive one tablet containing tenofovir disoproxil 245 mg and emtricitabine 200 mg orally once daily for 28 days as the PEP backbone.
Raltegravir for PEPGive 1200 mg orally once daily for 28 days with tenofovir disoproxil and emtricitabine under the current UK PEP regimen.