Executive summary (PEP is time-critical)
PEP should be started as soon as possible after a significant exposure, ideally within hours and no later than 72 hours (after 72 hours it is generally not recommended). In the UK, initiation is typically via sexual health services or the Emergency Department; primary care’s role is often rapid triage and signposting.
- Assess exposure risk (type of exposure + source status/viral load + timing).
- Start/arrange PEP urgently if indicated; don’t delay for “perfect” information.
- Arrange baseline tests and follow-up per local protocol.
Baseline actions (what to organise immediately)
- HIV test at baseline (to exclude existing infection).
- Renal function (TDF is renally cleared), LFTs.
- Hepatitis B status (HBsAg, anti-HBc, anti-HBs) and hepatitis C baseline testing (local protocol).
- Pregnancy test where relevant; consider drug–drug interactions (e.g., anticonvulsants, rifampicin, St John’s wort).
- STI screen and safeguarding considerations when appropriate.
Typical PEP regimen (UK – check local formulary)
Duration: 28 days.
| Drug | Typical adult dose | Notes |
|---|---|---|
| Tenofovir disoproxil / Emtricitabine (TDF/FTC) | 245/200 mg once daily | Check eGFR; caution with nephrotoxic drugs. |
| Raltegravir | 1200 mg once daily or 400 mg twice daily | Local protocol varies; assess interactions. |
| Alternative integrase inhibitor (e.g., dolutegravir) | 50 mg once daily | Used in some pathways; consider pregnancy guidance and interactions. |
Do not copy-paste blindly: use the BHIVA/BASHH guideline + local ED/sexual health protocol, and check the BNF/SPC for contraindications and interactions.
Follow-up (what patients should expect)
- Early review for side-effects/adherence (often within 48–72 hours or 1 week).
- Repeat HIV testing at the recommended intervals (local protocols vary; often at 6 and 12 weeks post-exposure).
- Assess ongoing risk and consider PrEP referral if repeated exposures are likely.
- Provide clear “return now” advice: rash/systemic illness, jaundice, severe GI side effects, or any new symptoms suggestive of seroconversion.
FAQ
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.