PEPSE Flashcards
Once HIV crosses mucosal barrier, how long until it is detectable in lymph nodes?
48-72 hours
What benefit is the initiation of antiretroviral therapy following exposure to HIV?
Reduces dissemination and replication of virus in all tissues
What factors may result in PEP failure? (5)
Delayed initiation Transmission of resistant virus Variable genital tract drug penetration Poor/non-adherence Further high-risk sexual exposure
PEP completion rates are historically low, what are they?
42-82%
What factors increase the risk of HIV transmission? (6)
High plasma HIV viral load Breaches in mucosal barrier - trauma or ulceration Menstruation STI (co infection) Ejaculation Non-circumcision
When should PEP be considered?
Transmission risk > 1 in 1000 - GIVE
Transmission risk 1 in 1000 - 1 in 10 000 - CONSIDER
If the source is HIV positive, when is PEP NOT recommended?
source on ART, >6 months, undetectable (VL <200)
When might PEP be considered if oral sex is the exposure type?
Primary HIV infection
Oropharyngeal trauma/ulceration
Once blood as dried, when does HIV become non-viable?
couple of hours
What is the HIV prevalence in female sex workers in Western, Central and Eastern Europe?
Western <1%
Central 1-2%
Eastern 2-8%
What is the IV prevalence in male sex workers?
14%
When should PEP be initiated?
As soon as possible
Preferably < 24 hours
Up to 72 hours
What is the recommended duration of PEP?
28 days
What is the recommended PEP of choice
Truvada and raltegravir
Recommend triple agent regimen
Truvada is the recommended NRTI back bone of PEP, why?
good genital tract and rectal tissue penetration
peak levels within 24h of dosing
maintaining high levels for up to seven days
Why not abacavir for PEP?
8% experience hypersensitivity reaction
What is an reasonable alternative to raltegravir, if required, for PEP?
Dolutegravir, no PEP data though
What is an alternative PEP regimen?
Combivir (zidovudine + lamivudine) with Protease inhibitor (lopinavir, darunavir, atazanavir with ritonavir) or Dolutegravir
If a person has chronic hepatitis B what NRTI is preferred as PEP?
Truvada
Why is NNRTI PEP ie nevirapine not recommended?
10% experience grade 3 or 4 hepatotoxicity
What are the limitations for PIs as PEP?
Frequent side effects
Risk of drug-drug interaction
When should STI testing be performed in the setting of PEP?
At baseline
2 weeks after risk
For people who get PEP, When should HIV testing take place?
8-12 weeks following exposure
What other tests should be done at baseline before PEP?
HIV, Hep B surface antigen. creatinine, ALT, urinalysis, pregnancy test
What are the risks to pregnancy if HIV acquired during it?
High viraemia associated with primary infection results in high likelihood of INTRAUTERINE TRANSMISSION
Is pregnancy a contraindication to PEP?
No, but woman should be counselled that ARVs are unlicensed in pregnancy
If a further high risk sexual exposure occurs near the end of PEP course, what advice should be given?
extend PEP for further 48 hours after last exposure
If a person keeps re-attending for PEP, what should be considered/offer?
Review of safer sex strategies
PREP (if available)
Consider involvementof psychology
If a person is on PEP prior to a HIV positive result, what should be done?
Continue PEP
Refer to HIV specialist
Consider ongoing ART to avoid viral rebound and increased transmission risk
What follow up of the potential source should take place?
Attempt to establish their HIV risk and status, if establish contact could stop PEP early
if drug resistance PEP should be altered
What hepatitis B vaccination schedule should be used for people presenting for PEP and non-immune to HBV?
Ultra-rapid hep B vaccination course
For women who present for PEP, what additional test should be performed?
pregnancy test
