HIV — SCE Infectious Diseases MCQ

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EasyHIV MedicineHIVSCE Infectious Diseases

A 28-year-old woman presents to the sexual health clinic. She had sexual intercourse with a man newly diagnosed with HIV 36 hours ago. She is currently on no medications and has a negative HIV point-of-care test. She has no renal impairment. What is the most appropriate management?

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Correct answer: E — Start PEP with Tenofovir DF/Emtricitabine plus Dolutegravir for 28 days

This is a significant sexual HIV exposure: she is HIV-negative at baseline, presented 36 hours after intercourse, and the source partner is newly diagnosed with HIV, so his viral load should be treated as unknown/detectable unless proven suppressed. HIV PEP should be started immediately because it is indicated up to 72 hours after exposure and should not be delayed while awaiting the source partner’s viral load. The course must be 28 days. Tenofovir disoproxil/emtricitabine with an integrase inhibitor is the appropriate regimen; dolutegravir 50 mg once daily is an accepted third-agent option with tenofovir DF/emtricitabine, giving option E. Option B is wrong because PEP is not given for 14 days. PrEP is for pre-exposure/ongoing prevention, not immediate management of a recent high-risk exposure, although it may be discussed after completing PEP if ongoing risk exists.

Reference: British Association for Sexual Health and HIV (BASHH) / British HIV Association (BHIVA). UK guideline for the use of HIV post-exposure prophylaxis 2021, amended 2023. https://bhiva.org/wp-content/uploads/2024/10/PEP-guidelines.pdf