From the Guidelines
After completing a 28-day HIV Post-Exposure Prophylaxis (PEP) regimen, patients should undergo HIV testing at 6 weeks, 3 months, and 6 months post-exposure to confirm they remain HIV-negative, and consider transitioning to Pre-Exposure Prophylaxis (PrEP) if HIV test results are negative and the patient is at ongoing risk of HIV exposure 1. The primary test used is the HIV antibody/antigen combination test, which can detect infection within 4-6 weeks of exposure.
- During these follow-up visits, healthcare providers should also assess for medication side effects and provide counseling on risk reduction strategies.
- No additional PEP medications are needed after completing the full 28-day course, which typically consists of a three-drug regimen such as tenofovir disoproxil fumarate/emtricitabine (Truvada) plus dolutegravir or raltegravir.
- Patients who experience ongoing high-risk behaviors should be evaluated for pre-exposure prophylaxis (PrEP) as a preventive measure, with a seamless transition from PEP to PrEP recommended if the patient is likely to be at risk of ongoing exposure 1. This extended testing schedule is necessary because while PEP is highly effective when started within 72 hours of exposure and completed fully, there remains a small possibility of seroconversion that must be ruled out through appropriate follow-up testing 1.
From the Research
Follow-up Testing after PEP
- The recommended follow-up testing protocol after completing a 28-day Post-Exposure Prophylaxis (PEP) regimen for Human Immunodeficiency Virus (HIV) exposure is not directly addressed in the provided studies.
- However, a study on postexposure prophylaxis for common infectious diseases 2 suggests that persons exposed to bloodborne pathogens should have baseline testing for human immunodeficiency virus, hepatitis B virus, and hepatitis C virus antibodies, and follow-up testing at six weeks, three months, and six months postexposure.
Timing of Follow-up Testing
- Another study on the effect of HIV pre-exposure prophylaxis (PrEP) on detection of early infection 3 found that undetectable HIV RNA would rebound to detectable levels within two months of PrEP cessation.
- This suggests that follow-up testing should be done at least two months after PEP cessation to detect potential HIV infection.
Treatment Protocol
- The provided studies do not specifically address the treatment protocol after completing a 28-day PEP regimen.
- However, a study on point-of-care tenofovir urine testing for the prediction of treatment failure and drug resistance during initial treatment for HIV-1 infection 4 found that objective adherence testing using a urine-TFV test predicted viral rebound with high specificity.
- This suggests that monitoring adherence to antiretroviral treatment (ART) is crucial in preventing treatment failure and drug resistance.