Australasian Society for HIV Viral Hepatitis and Sexual Health Medicine (ASHM), June 2023
ASHM has updated the National Guidelines for Post-Exposure Prophylaxis (PEP) after non-occupational and occupational exposure to HIV .
These guidelines outline the updated Australian recommendations for human immunodeficiency virus (HIV) post-exposure prophylaxis (PEP) following potential or known exposure to HIV in sexual, occupational, and non-occupational settings. Risk of transmission, the timing of PEP, baseline assessment, preferred regimen and follow-up are outlined, including the use of PEP in the era of the Pharmaceutical Benefits Scheme (PBS)-subsidised HIV pre-exposure prophylaxis (PrEP).
New to the Guidelines:
- The recommended first-line two-drug post-exposure prophylaxis (PEP) regimen is co-formulated tenofovir disoproxil and emtricitabine, with the addition of dolutegravir 50 mg daily OR raltegravir 1200 mg daily for 28 days when three-drug PEP is recommended
- Advice on how to privately prescribe two-drug PEP at a reasonable cost is provided for general practitioners (GPs) who are not authorised to prescribe human immunodeficiency virus (HIV) s100 drugs
- Rilpivirine is no longer recommended for three-drug PEP
- PEP starter packs are discouraged; the full 28-day course should generally be provided at the initial consultation
- Because most Australian people with HIV are on antiretroviral therapy with an undetectable viral load, the prevalence of detectable HIV viraemia in the source population has been used to determine HIV transmission risk where the source HIV status is unknown
- A new source category of men who have sex with men and who inject drugs has been added in recognition of the higher proportion of this group who are viraemic than those men who have sex with men who do not inject drugs in Australia
- Removal of the arbitrary, non-evidence-based, numerical thresholds at which PEP was indicated and replacement with advice to guide an individual risk-benefit assessment
- Further guidance on the generally low-risk scenario of human bites is included.
- All children younger than 16 years of age who qualify for HIV PEP are recommended to receive combination therapy with three drugs. This strategy differs from the risk-stratified approach used in adults, where two or three drugs may be considered depending on the risk-exposure event.
- For PEP in children, a single fixed drug-combination option is now provided (Biktarvy®) which may improve compliance.