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Profilaxis postexposición al VIH

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最后审阅： 18 Jan 2026
最后更新： 01 Aug 2023

小结

定义

病史和体格检查

关键诊断因素

  • presencia de factores de riesgo
  • exposición al VIH en las 72 horas anteriores
  • rotura, desplazamiento o ausencia de uso de condón
  • antecedentes de eyaculación del sujeto fuente
  • traumatismo o lesión en la piel
  • úlceras genitales
  • sujeto fuente proveniente del grupo de alto riesgo para la viremia del VIH
  • sujeto fuente proveniente de un área geográfica con una alta prevalencia de VIH
  • antecedentes sexuales de alto riesgo en la persona expuesta
  • carga viral de VIH detectable en el sujeto fuente
完整详情

其他诊断因素

  • antecedentes de prueba negativa de VIH en el sujeto fuente
  • sujeto fuente con infección simultánea por hepatitis
  • resistencia antiviral al VIH en el sujeto fuente
  • medicación actual con o sin receta
  • antecedentes de alergias a fármacos
  • enfermedades seudogripales
完整详情

危险因素

  • transfusión de sangre proveniente de un donante infectado por el VIH
  • equipo para inyectar compartido
  • lesión por pinchazo de aguja
  • rol pasivo en coito anal
  • rol pasivo en coito vaginal
  • exposición en membrana mucosa
  • rol activo en coito anal
  • rol activo en coito vaginal
  • rol pasivo en sexo oral (felación)
完整详情

诊断性检查

首要检查

  • análisis de antígeno/anticuerpos del VIH en sangre (ELISA o EIA en sangre)
  • pruebas de diagnóstico rápido (POCT) para VIH en el punto de atención
  • pruebas de función renal
  • pruebas de función hepática (PFH)
  • serología de hepatitis B
  • anticuerpo contra el virus de la hepatitis C
  • serología de sífilis
  • prueba de embarazo
  • cribado de otras ETS
完整详情

需考虑的检查

  • carga viral del VIH si hay síntomas de seroconversión del VIH
完整详情

治疗流程

急症处理

adultos o adolescentes ≥13 años: no embarazadas

embarazada o en periodo de lactancia materna

niños

撰稿人

作者

Ming Jie Lee, BSc(Hons), MBBS, MRCP

Clinical Research Fellow

Department of Infectious Disease

Imperial College London

London

UK

利益声明

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

利益声明

JF declares that she has no competing interests.

鸣谢

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.

利益声明

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.

同行评议者

Professor Margaret Johnson, MB BS, MD, FRCP

Clinical Director

HIV/AIDS Services

Royal Free Hampstead NHS Trust

London

UK

利益声明

MJ declares that she has no competing interests.

William Rodriguez, MD

Chief Medical Officer

Foundation for Innovative New Diagnostics (FIND)

Campus Biotech

Geneva

Switzerland

利益声明

Not disclosed.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

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.

关键文献

British Association for Sexual Health and HIV; Asanati K, Bhagani S, Boffito M, et al. UK guideline for the use of HIV post-exposure prophylaxis. 2021 [internet publication].全文

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].全文

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].全文

New York State Department of Health AIDS Institute. PEP to prevent HIV infection. Aug 2023 [internet publication].全文

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].全文

参考文献

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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