PEP and PrEP

Question 1

Features and effectiveness of PrEP

Answer 1

1 or 2 drugs orally

if taken properly, is 85% effective

Question 2

Immediate post-exposure action (10)

Answer 2

run under water for 5-10 mins

clean thoroughly w. soap and water w/o scrubbing

if mucosal surface affected, irrigate w. water before and after removing contact lenses

take down details of donor

report to occupational health-file accident form

store blood from both parties-test for HBV, HCV, HIV

active and passive immunisation vs HBV

council and test recipient at 3,6 and 12mo

if donor HIV+ve, ask about CD4 count and viral load

was the innoculum big?

Question 3

Criteria for PEP

Answer 3

PEP needed if risk of transmission >1/1000

not needed if donor has undetectable viral load for >6mo

needs to be started w/i 72hrs of exposure and is most effective <24hrs after exposure.

need to do pregnancy test before

Question 4

Duration and review dates for PEP

Answer 4

4wks Rx

review at 2, 4 and 12wks

Question 5

Tests during 1st appointment (8)

Answer 5

give 2wks Rx

STI screen-not GC/CT as thye’ll be -ve

PEP baseline bloods:

• LFTs-PEP can affect liver
• creatinine
• HAV if MSM
• HBV
• syphilis
• urine analysis

Question 6

Tests during 2nd appointment (5)

Answer 6

another 2wks Rx

adherence

PEP SEs

test for GC/CT

review hep immunity and need for vaccination

Question 7

Tests during 3rd appointment (5)

Answer 7

HIV serology

HBsAg

STI screen if not done at 2wks

syphilis screen (only +ve after 6wks)

HCV:

• PCR if known contact/exposure
• Ab otherwise

Question 8

Criteria for HIV+ve clinician to carry out exposure-prone procedures (4)

Answer 8

have 3-monthly viral load testing

be under supervision of a consultant occupational health physician

be registered on UKAP occ H monitoring register

have 2 viral load levels <200, 3mo apart

if viral load:

• 200-1,000: do another viral load 10d later and if this is high, cease EPP
• if >1,000, cease EPP immediately

if healthcare worker fails to attend 3-monthly testing, occ H consultant should inform the worker’s manager and CDC that they cannot perform EPPs

Question 9

examples of EPPs

Answer 9

when sharps included/hands inside body cavity:

• dental surgery
• abdo surgery

not EPP:

• venepuncture
• DRE
• endoscopy

Question 10

SEs of PEP (4)

Answer 10

fatigue/malaise

diarrhoea

headache

nausea/vomitting