Summary
Definition
History and exam
Key diagnostic factors
- 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
Other diagnostic factors
- 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
Risk factors
- 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)
Diagnostic tests
1st tests to order
- 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
Tests to consider
- carga viral del VIH si hay síntomas de seroconversión del VIH
Treatment algorithm
adultos o adolescentes ≥13 años: no embarazadas
embarazada o en periodo de lactancia materna
niños
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.
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.
References
Key articles
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].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
- Guidelines for the management of people living with HIV in Europe
More GuidelinesFolletos para el paciente
VIH: tratamiento de prevención (PrEP)
Hepatitis C: ¿qué es?
Más Folletos para el paciente
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