Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- exposição ao vírus da imunodeficiência humana (HIV) nas últimas 72 horas
- rompimento, deslocamento ou não uso do preservativo
- história de ejaculação do indivíduo-fonte
- trauma ou lesão na pele
- úlceras genitais
- indivíduo-fonte do grupo de alto risco para viremia do HIV
- indivíduo-fonte de área geográfica com alta prevalência de infecção pelo HIV
- história sexual de alto risco na pessoa exposta
- carga viral do HIV detectável no indivíduo-fonte
Other diagnostic factors
- história de exame HIV-negativo no indivíduo-fonte
- indivíduo-fonte com coinfecção por hepatite
- resistência antiviral para HIV no indivíduo-fonte
- medicamentos com prescrição médica atual ou sem prescrição
- história de alergias a medicamentos
- doença semelhante à gripe
Risk factors
- transfusão de sangue de um doador HIV-positivo
- compartilhamento de dispositivos para injeção
- lesão por picada de agulha
- penetração anal receptiva
- penetração vaginal receptiva
- exposição da membrana mucosa
- penetração anal insertiva
- penetração vaginal insertiva
- sexo oral receptivo (felação)
Diagnostic investigations
1st investigations to order
- teste de antígeno/anticorpo anti-HIV no sangue (ensaio de imunoadsorção enzimática [ELISA] ou ensaio imunoenzimático [EIE] no sangue)
- teste laboratorial remoto rápido de HIV
- testes de função renal
- testes da função hepática
- sorologia para hepatite B
- anticorpo contra o vírus da hepatite C
- sorologia para sífilis
- teste de gravidez
- rastreamento de outras ISTs
Investigations to consider
- carga viral do HIV se houver sintomas de soroconversão do HIV
Treatment algorithm
adultas ou adolescentes ≥13 anos: não gestantes
gestantes ou lactantes
crianças
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 GuidelinesPatient information
HIV: testagem
HIV: tratamento preventivo (PPrE)
More Patient information
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