Summary
Definition
History and exam
Key diagnostic factors
- exposure to HIV within past 72 hours
- breakage, slippage, or nonusage of a condom
- history of ejaculation from source
- trauma or skin break
- genital ulcers
- source from high-risk group for HIV viremia
- source from geographic area with high HIV prevalence
- high-risk sexual history in exposed person
- detectable HIV viral load in source
Other diagnostic factors
- history of negative HIV test in source
- source with hepatitis coinfection
- antiviral HIV resistance in source
- current prescription or nonprescription medications
- history of drug allergies
- flu-like illness
Risk factors
- blood transfusion from HIV-positive donor
- sharing injecting equipment
- needlestick injury
- receptive anal intercourse
- receptive vaginal intercourse
- mucus membrane exposure
- insertive anal intercourse
- insertive vaginal intercourse
- receptive oral sex (fellatio)
Diagnostic investigations
1st investigations to order
- HIV antigen/antibody blood test (blood ELISA or EIA)
- rapid HIV point of care test (POCT)
- renal function tests
- liver function tests (LFTs)
- hepatitis B serology
- hepatitis C antibody
- syphilis serology
- pregnancy test
- screening for other STIs
Investigations to consider
- HIV viral load if symptoms of HIV seroconversion
Treatment algorithm
adults or adolescents ≥13 years: nonpregnant
pregnant or breastfeeding
children
Contributors
Authors
Ming Jie Lee, BSc(Hons), MBBS, MRCP
Clinical Research Fellow
Department of Infectious Disease
Imperial College London
London
UK
Disclosures
MJL has received consulting fees from Thriva Ltd. and conference reimbursement from Gilead Sciences, Inc., and travel grants from ViiV Healthcare, not related to this work.
Julie Fox, BSc(Hons), MBChB, MRCP, MD
HIV consultant and Honorary Senior Lecturer KCL
Department of HIV
Harrison Wing
Guy’s and St Thomas Hospital NHS Foundation Trust
London
UK
Disclosures
JF declares that she has no competing interests.
Acknowledgements
Dr Ming Jie Lee and Dr Julie Fox would like to gratefully acknowledge Dr Jennifer A. Johnson, Dr Paul Sax, Dr Rebecca Plank, Dr Michael Brady, Dr Emily Cheserem, and Dr Claire M. Naftalin, the previous contributors to this topic.
Disclosures
JAJ declares that she has no competing interests. PS serves as a consultant for Abbott, BMS, Gilead, GSK, Merck, and Janssen. He receives grant support from BMS, Gilead, and GSK. EC has been sponsored by GlaxoSmithKline for several conferences and sponsored by Gilead Sciences, Bristol-Myers Squibb Pharmaceuticals, and Abbott Laboratories to attend various educational programs. CMN has been sponsored by Bristol-Myers Squibb Pharmaceuticals to attend an educational program. CMN is an author of a reference cited in this topic. MB not disclosed. RP declares that she has no competing interests.
Peer reviewers
Professor Margaret Johnson, MB BS, MD, FRCP
Clinical Director
HIV/AIDS Services
Royal Free Hampstead NHS Trust
London
UK
Disclosures
MJ declares that she has no competing interests.
William Rodriguez, MD
Chief Medical Officer
Foundation for Innovative New Diagnostics (FIND)
Campus Biotech
Geneva
Switzerland
Disclosures
Not disclosed.
References
Key articles
British Association for Sexual Health and HIV. UK guideline for the use of HIV post-exposure prophylaxis. 2021 [internet publication].Full text
Centers for Disease Control and Prevention; US Department of Health and Human Services. Updated guidelines for antiretroviral postexposure prophylaxis after sexual, injection drug use, or other nonoccupational exposure to HIV - United States, 2016. May 2018 [internet publication].Full text
World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach, 2nd ed. 2016 [internet publication].Full text
New York State Department of Health AIDS Institute. PEP to prevent HIV infection. Aug 2023 [internet publication].Full text
World Health Organization. Updated recommendations on first-line and second-line antiretroviral regimens and post-exposure prophylaxis and recommendations on early infant diagnosis of HIV. Jan 2018 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Guidelines
- PEP to prevent HIV infection
- UK guideline for the use of HIV post-exposure prophylaxis
More GuidelinesPatient information
Hepatitis C: what is it?
HIV: prevention treatment (PrEP)
More Patient information
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