What is the post-exposure prophylaxis (PEP) for Human Immunodeficiency Virus (HIV) after a needle prick from an unknown person?

HIV Post-Exposure Prophylaxis After Needle Prick from Unknown Source in India

Start post-exposure prophylaxis (PEP) immediately if you present within 72 hours of the needle prick injury, ideally within 24 hours, using a 28-day course of combination antiretroviral therapy, even when the source person's HIV status is unknown. 1

Immediate Actions (Within Minutes to Hours)

• Wash the puncture site immediately with soap and water 2
• Do not delay seeking medical care - the sooner PEP is initiated, the more effective it is at preventing HIV transmission 1
• Present to a healthcare facility within 72 hours (ideally within 24 hours) as PEP effectiveness decreases significantly after this window 1

Risk Assessment for Your Specific Situation

Understanding Your Risk Level

Needle prick injuries from discarded needles in public settings carry low but real risk:

• The overall risk of HIV transmission from a percutaneous needle injury with HIV-infected blood is approximately 0.3-0.36% (3-4 per 1,000 exposures) 3, 4
• However, needles discarded in public places have even lower risk because only 3.8% of syringes used by HIV-infected persons contain detectable HIV RNA 1, 2
• Viable HIV virus is recovered from only 8% of needles after 21 days at room temperature, and less than 1% remain viable after one week at higher temperatures 1, 2
• Despite low risk, no HIV infections from discarded needles have been documented in medical literature 1

Factors That Increase Risk (If Applicable)

• Deep penetrating injury 4
• Visible blood on the needle 4
• Hollow-bore needle that was recently in someone's vein or artery 2, 4
• Large-bore needle (versus small insulin needles) 1

PEP Initiation Decision

The 2025 CDC guidelines recommend evaluating PEP on a case-by-case basis when the source HIV status is unknown, but given the consequences of HIV infection versus the manageable risks of PEP medications, initiation is reasonable for substantial exposures. 1

When to Start PEP

• Start PEP if the exposure occurred within 72 hours (preferably within 24 hours) 1
• Do not wait for HIV test results before starting the first dose 1
• Consider starting PEP while attempting to determine if the source could be from a high HIV prevalence population (injection drug users, commercial sex workers) 1
• If you present after 72 hours, PEP is not recommended as animal and human data show it is unlikely to prevent transmission at that point 1

Recommended PEP Regimen (2025 Guidelines)

Preferred regimens for adults and adolescents: 1

1. Bictegravir/emtricitabine/tenofovir alafenamide (single tablet once daily), OR
2. Dolutegravir plus (tenofovir alafenamide or tenofovir disoproxil fumarate) plus (emtricitabine or lamivudine) 1

• Duration: Complete the full 28-day course 1
• The first dose should be provided immediately at the initial visit 1

Testing Protocol

Baseline Testing (Day 0)

• Rapid HIV test or laboratory-based antigen/antibody combination HIV test before starting PEP 1
• Do not delay the first PEP dose while waiting for laboratory results 1

Follow-Up Testing Schedule

• 24-hour follow-up (can be remote or in-person) with healthcare provider 1
• 4-6 weeks post-exposure: HIV testing 1
• 12 weeks post-exposure: Final HIV testing 1

Critical Pitfalls to Avoid

• Do not delay PEP initiation beyond 72 hours - effectiveness drops dramatically 1
• Do not stop PEP prematurely - the full 28-day course is essential 1
• Do not use PEP as a substitute for ongoing prevention if you have frequent exposures; instead, consider pre-exposure prophylaxis (PrEP) 1
• Do not attempt to test the needle itself for HIV - this is not reliable or recommended 1

Additional Considerations for India

• Seek care at a government tertiary hospital or designated ART (antiretroviral therapy) center where PEP is typically available 5
• Consider hepatitis B vaccination if not already immune, as hepatitis B transmission risk from needle injuries is much higher (6-30%) than HIV 6
• Request hepatitis B and hepatitis C testing as part of your evaluation 1, 6

Medication Side Effects Management

• Common side effects include nausea and gastrointestinal symptoms 1
• Anti-nausea medications (antiemetics) or anti-diarrheal agents can improve adherence 1
• Report any severe symptoms immediately to your healthcare provider 1

Long-Term Prevention

• If you continue to have potential HIV exposures, discuss transitioning to pre-exposure prophylaxis (PrEP) with your provider after completing PEP 1
• Ensure proper disposal of any sharps you encounter in the future 2