PEPSE

Question 1

When is the latest that PEPSE can be offered after exposure?

Answer 1

Preferably within 24h

Can one offered up to 72h

Question 2

What is first line regimen for PEPSE

Answer 2

Truvada and Raltegravir

Question 3

When is follow-up HIV testing required

Answer 3

At 8-12 weeks after exposure

Question 4

What to do if they have further risk during last 2 days of PEPSE?

Answer 4

Continue PEPSE for 48h

Question 5

What if HIV is diagnosed during use of PEPSE?

Answer 5

Continue PEPSE pending referral to HIV specialist

Question 6

What do if PEPSE is missed for >48h

Answer 6

STOP

Question 7

At what HIV transmission risk should PEP be offered

Answer 7

Where risk is >1 in 1000

Question 8

What is alternative is patient can’t have 1st line PEPSE?

Answer 8

Combivir (Zidovudine 250mg twice daily plus lamivudine 150mg twice daily)

Protease inhibitor
Kaletra (lopinavir 200mg, ritonavir 50mg) Two tablets twice daily
OR
Darunavir 800mg once daily + ritonavir 100mg once daily OR
Atazanavir 300mg once daily + ritonavir 100mg once daily OR
Dolutegravir 50mg once daily

Question 9

What else should you consider in a woman requesting PEPSE?

Answer 9

Pregnancy test (although pregnancy should not affect decision to start PEPSE)- but must advise that unlicensed in pregnancy

Question 10

Why might PEPSE fail?

Answer 10

Delayed initiation >72h
Transmission of a resistant virus
Variable GT drug penetration
Poor adherence
Further high risk exposure

Question 11

What is infant PEPSE?

Answer 11

zidovudine mono therapy if mum VL <50 at 36/40

3 drug therapy if not/mum untreated- for 4 weeks