Southern African HIV Clinicians Society 2023 Guideline for post-exposure prophylaxis: Updated recommendations

Abstract

The administration of a short course of antiretroviral therapy to an HIV-negative person who has been exposed to the human immunodeficiency virus (HIV-1) to prevent acquisition of the virus is known as post-exposure prophylaxis (PEP): • PEP is used as a preventive intervention. • PEP is an emergency intervention for all persons exposed to HIV. • The exposure may be occupational or non-occupational. • The route of exposure may be sexual, percutaneous or via non-genital mucosal membranes. • PEP can effectively prevent infection in a person exposed to HIV when initiated as soon as possible and at least within 72 h post-exposure. • While one or two antiretrovirals can be used in pre-exposure prophylaxis (PrEP), the global recommendation for PEP is a 3-drug regimen involving, whenever possible, an integrase inhibitor (usually dolutegravir). • The risk:benefit assessment falls firmly in favour of prescribing PEP, as integrase inhibitor-based regimens are very safe. • The recommended duration of a course of PEP is 28 days. The full 28-day course should be provided at the time of PEP initiation. • Almost all PEP is now 28 days of first-line ART (i.e., tenofovir disoproxil, lamivudine and dolutegravir [TLD]). • In instances of repeated PEP use in an individual, it is important to assess the potential benefit of PrEP going forward.