What if I've been exposed to HIV?

Post-Exposure Prophylaxis for HIV After Potential Exposure

If you've been exposed to HIV, you should seek medical care immediately (within 72 hours) to evaluate for post-exposure prophylaxis (PEP), which can significantly reduce your risk of HIV infection if started promptly.

Immediate Assessment After Potential HIV Exposure

• Timing is critical - PEP is only effective if initiated within 72 hours of exposure, with greater effectiveness the sooner it is started 1
• Baseline HIV testing should be performed immediately, ideally with a rapid test kit 1
• The exposure should be evaluated for potential to transmit HIV based on:
  • Type of exposure (sexual contact, injection drug use, needlestick) 2
  • Body fluid involved (blood, genital secretions, other potentially infectious fluids) 2
  • Route and severity of exposure 2

Risk Assessment Factors

• Higher risk exposures include:
  • Receptive anal intercourse (highest risk) 1
  • Insertive anal intercourse 1
  • Receptive vaginal intercourse 1
  • Insertive vaginal intercourse 1
  • Oral sex (lower risk) 1
• Source partner risk factors:
  • Known HIV-positive status 2
  • Belonging to high-prevalence groups (e.g., injection drug users, men who have sex with men) 2, 1
  • Unknown HIV status but from high-prevalence group 3

PEP Recommendations Based on Risk Assessment

• For exposure to a known HIV-positive source with substantial risk:
  • A 28-day course of highly active antiretroviral therapy (HAART) is recommended if within 72 hours 2
• For exposure to a source with unknown HIV status:
  • PEP should be evaluated on a case-by-case basis, considering the risks and benefits 2, 3
  • May be recommended if the source is from a high-prevalence group and exposure represents substantial risk 3
• PEP is NOT recommended when:
  • More than 72 hours have passed since exposure 4
  • The exposure presents a negligible risk for transmission 2
  • For persons with frequent recurrent exposures 2

Medication Regimen

• If PEP is indicated, a 28-day course of HAART is recommended 2
• Preferred regimens include:
  • Efavirenz and lamivudine or emtricitabine with zidovudine or tenofovir 2
  • Lopinavir/ritonavir and zidovudine with either lamivudine or emtricitabine 2
• Medications should be started as soon as possible after exposure 2
• Side effects should be managed proactively to improve adherence 2

Follow-up Care

• HIV testing at 4-6 weeks, 3 months, and 6 months after exposure 2
• Testing for other sexually transmitted infections 2
• Hepatitis B testing and vaccination if not immune 1
• For women with genital exposure to semen, emergency contraception should be discussed 2
• Risk-reduction counseling to prevent future exposures 2

Special Considerations

• For patients with ongoing risk, transition to pre-exposure prophylaxis (PrEP) without interruption after completing PEP 1
• Sexual assault survivors need additional supportive services to improve adherence to PEP 2
• Injection drug users should not be deterred from receiving PEP and should be assessed for interest in substance abuse treatment 2

Common Pitfalls to Avoid

• Delaying initiation of PEP beyond 72 hours significantly decreases effectiveness 4
• Using PEP for recurrent high-risk behaviors instead of transitioning to PrEP 4
• Poor medication adherence leading to incomplete PEP course 5
• Failing to provide comprehensive sexual health counseling and risk reduction strategies 1

Remember that PEP is an emergency intervention and not intended for regular use. For individuals with ongoing risk, PrEP (pre-exposure prophylaxis) is a more appropriate long-term strategy 1, 6.