PEPSE

Question 1

Once HIV crosses mucosal barrier, how long until it is detectable in lymph nodes?

Answer 1

48-72 hours

Question 2

What benefit is the initiation of antiretroviral therapy following exposure to HIV?

Answer 2

Reduces dissemination and replication of virus in all tissues

Question 3

What factors may result in PEP failure? (5)

Answer 3

Delayed initiation
Transmission of resistant virus
Variable genital tract drug penetration
Poor/non-adherence
Further high-risk sexual exposure

Question 4

PEP completion rates are historically low, what are they?

Answer 4

42-82%

Question 5

What factors increase the risk of HIV transmission? (6)

Answer 5

High plasma HIV viral load
Breaches in mucosal barrier - trauma or ulceration
Menstruation
STI (co infection)
Ejaculation
Non-circumcision

Question 6

When should PEP be considered?

Answer 6

Transmission risk > 1 in 1000 - GIVE

Transmission risk 1 in 1000 - 1 in 10 000 - CONSIDER

Question 7

If the source is HIV positive, when is PEP NOT recommended?

Answer 7

source on ART, >6 months, undetectable (VL <200)

Question 8

When might PEP be considered if oral sex is the exposure type?

Answer 8

Primary HIV infection

Oropharyngeal trauma/ulceration

Question 9

Once blood as dried, when does HIV become non-viable?

Answer 9

couple of hours

Question 10

What is the HIV prevalence in female sex workers in Western, Central and Eastern Europe?

Answer 10

Western <1%
Central 1-2%
Eastern 2-8%

Question 11

What is the IV prevalence in male sex workers?

Answer 11

14%

Question 12

When should PEP be initiated?

Answer 12

As soon as possible
Preferably < 24 hours
Up to 72 hours

Question 13

What is the recommended duration of PEP?

Answer 13

28 days

Question 14

What is the recommended PEP of choice

Answer 14

Truvada and raltegravir

Recommend triple agent regimen

Question 15

Truvada is the recommended NRTI back bone of PEP, why?

Answer 15

good genital tract and rectal tissue penetration
peak levels within 24h of dosing
maintaining high levels for up to seven days

Question 16

Why not abacavir for PEP?

Answer 16

8% experience hypersensitivity reaction

Question 17

What is an reasonable alternative to raltegravir, if required, for PEP?

Answer 17

Dolutegravir, no PEP data though

Question 18

What is an alternative PEP regimen?

Answer 18

Combivir (zidovudine + lamivudine) with Protease inhibitor (lopinavir, darunavir, atazanavir with ritonavir) or Dolutegravir

Question 19

If a person has chronic hepatitis B what NRTI is preferred as PEP?

Answer 19

Truvada

Question 20

Why is NNRTI PEP ie nevirapine not recommended?

Answer 20

10% experience grade 3 or 4 hepatotoxicity

Question 21

What are the limitations for PIs as PEP?

Answer 21

Frequent side effects

Risk of drug-drug interaction

Question 22

When should STI testing be performed in the setting of PEP?

Answer 22

At baseline

2 weeks after risk

Question 23

For people who get PEP, When should HIV testing take place?

Answer 23

8-12 weeks following exposure

Question 24

What other tests should be done at baseline before PEP?

Answer 24

HIV, Hep B surface antigen. creatinine, ALT, urinalysis, pregnancy test

Question 25

What are the risks to pregnancy if HIV acquired during it?

Answer 25

High viraemia associated with primary infection results in high likelihood of INTRAUTERINE TRANSMISSION

Question 26

Is pregnancy a contraindication to PEP?

Answer 26

No, but woman should be counselled that ARVs are unlicensed in pregnancy

Question 27

If a further high risk sexual exposure occurs near the end of PEP course, what advice should be given?

Answer 27

extend PEP for further 48 hours after last exposure

Question 28

If a person keeps re-attending for PEP, what should be considered/offer?

Answer 28

Review of safer sex strategies
PREP (if available)
Consider involvementof psychology

Question 29

If a person is on PEP prior to a HIV positive result, what should be done?

Answer 29

Continue PEP
Refer to HIV specialist
Consider ongoing ART to avoid viral rebound and increased transmission risk

Question 30

What follow up of the potential source should take place?

Answer 30

Attempt to establish their HIV risk and status, if establish contact could stop PEP early
if drug resistance PEP should be altered

Question 31

What hepatitis B vaccination schedule should be used for people presenting for PEP and non-immune to HBV?

Answer 31

Ultra-rapid hep B vaccination course

Question 32

For women who present for PEP, what additional test should be performed?

Answer 32

pregnancy test