Pep Flashcards
What to discuss when starting pep
How works Start ASAP Adherence Side effects - dizziness, headache, nausea Drug interactions multivitamins antacid iron Sx of seroconversion Follow up Hiv test 28 days 45 days post finishing pep need hiv test Condoms until follow up Support
When to do hiv testing for pep
Baseline
45 days post finishing pep course
Risk factors increasing transmission for HIV
Menses Pregnant Skin breaks High viral load Sti
When to px pep post sexual exposure
Receptive anal and hiv pos Insertive anal and hiv pos Post SA consider Sex workers consider Receptive vaginal and hiv pos Insertive anal and hiv pos consider Sharing needles or sharps and hiv pos give pep Unknown hiv status and high risk group - give for receptive anal and consider for insertive
When to give pep for human bite
Saliva contaminated with blood
Biter known to be hiv pos with viral load >3 log copies
Deep tissue severe injury
Pep meds 1st line
Tenofovir disproxil 245mg
Plus Emtricitabine 200mg plus
Raltegravir 1200mg daily
First line pep for preggers women
Same but raltegravir dose 400mg BD or 600mg BD until can get the 400s
Side effects of truvada
Headache Dizziness Diarrhoea and nausea Can give renal toxicity Can get raised alt
Pep for Renal if egfr <50
Descovy (TAF) 25mg OD
Plus
Raltegravir 400mg BD or
Dolutegravir 50mg OD(not in first 6 weeks pregnancy)
Or
Darunavir
Atazanavir
Pep drug interactions
Raltegravir and antacids, multivitamins with iron, aluminium or magnesium (metal cations)
Dolutegravir no Iām first 6 weeks
Truvada well tolerated
Baseline pep assessment
PT Hiv 4th gen Hep b surface antigen - if less than 10 ultra rapid vaccine Hep c Creatinine and egfr Alt Stis repeat at 2 weeks Sts at 12 weeks
When to give pep if on prep
Anal sex if fewer than 4 pills in past week
Vaginal if not had 6 tabs in past week and more than 48 hours post last dose
When to stop pep due to missed doses
If over 48 hours since last dose
When to continue pep beyond the 28 days
Hiv pos
Seroconversion Sx
Hep b new diagnosis
If high risk anal exposure 48 more pep, if high risk vaginal - 7/7 more pep
