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Post-exposure HIV prophylaxis

Last reviewed: 2 Apr 2025
Last updated: 01 Aug 2023

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
Full details

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
Full details

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)
Full details

Diagnostic tests

1st tests 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
Full details

Tests to consider

  • HIV viral load if symptoms of HIV seroconversion
Full details

Treatment algorithm

ACUTE

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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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.

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