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Talking to Your Doctor About nPEP

May 2007


Introduction

Please share this with your health provider. If your doctor does not have a great deal of HIV experience, he or she may want to contact a more experienced provider to support making decisions around nPEP. San Francisco General Hospital has a 24-hour PEPline, which offers guidance around occupational HIV PEP. It may also help providers making decisions for non-occupational PEP (nPEP). The phone number is 1-888-448-4911. Provider AIDS Training (PAT) Warm Line (800-933-3413), with skilled staff to support doctors with anti-HIV drug management decisions. These resources are for health care providers only.


A Few Points to Consider

A doctor should be aware of the issues concerning the care of someone with a possible HIV exposure. A few points to consider include:


Discussion Points and Comments

Step One

Did the possible HIV exposure occur within the past 72 hours? Can anti-HIV therapy be started within those 72 hours?


Step Two

Are you currently HIV-positive?


Step Three

Conduct a risk assessment. What is the chance that the activity(ies) that put you at risk resulted in an HIV exposure or infection?


Step Four

What is the chance that the source (like a sexual partner or needle) was HIV-infected?


Step Five

Based on the risk and source assessment, is nPEP reasonable to consider?


Choosing an nPEP Regimen

Step One

Is the person seeking nPEP a woman?


Step Two

Is the HIV status of the sex partner or source of exposure known?


Step Three

Once a regimen is chosen, discuss side effects, adherence and monitoring


Step Four

If nPEP remains a desired option ...


Step Five

If nPEP is no longer a desired option ...


Suggested Schedule for nPEP

The CDC has funded a 24-hour national PEP registry for non-occupational HIV exposure: 1-877-448-1737 and www.HIVpepregistry.org. Its purpose is to collect information about the use and impact of nPEP among people at risk for HIV. The registry is entirely anonymous and no names or personal identifiers are collected.


Visit #1: Medical Evaluation

Note: HIV RNA tests are NOT recommended for diagnosing HIV infection. The false positive rate is high and may cause undue anxiety for the patient.


Visit #2: Week 1


Visit #3: 1 Month


Visit #4: 6 Weeks


Visit #5: 3 Months


Visit #6: 6 Months


Recommended Lab Evaluation for nPEP of HIV Infection


Test Baseline During nPEP* 4-6 Wks After Exposure 3 Mos After Exposure 6 Mos After Exposure

  HIV antibody test

E†, S§

 

E

E

E

  CBC with differential

E

E

     

  Serum liver enzymes

E

E

     

  Blood urea nitrogen/creatinine

E

E

     

  STD screen

E, S

   

  Hepatitis B serology

E, S

 

 

  Hepatitis C serology

E, S

   

E

E

  Pregnancy test

E

   

  HIV viral load

S

 

E**

E**

E**

  HIV resistance test

S

 

E**

E**

E**

  CD4+ T lymphocyte count

S

 

E**

E**

E**

* Other specific tests might be indicated dependent on the antiretrovirals prescribed. Literature pertaining to individual agents should be consulted.

† E = exposed patient. S = source.

§ HIV antibody testing of the source patient is indicated for sources of unknown serostatus.

º Additional testing for pregnancy, STDs, and HBV should be done as clinically indicated.

** If determined to be HIV infected on follow-up testing, perform as clinically indicated once diagnosed.


nPEP Resource List

These resources may be useful for people seeking information about nPEP and related issues. While Project Inform provides this publication, it is not an HIV prevention organization and does not answer calls on prevention, high-risk behaviors or risk reduction. Project Inform's Hotline answers questions about HIV disease, its treatments and related conditions. Do not call the Hotline about questions prevention. You will be referred to other resources. Some are listed below.


HIV Prevention


Domestic Violence and Rape Crisis


HIV/AIDS Treatment Information Resources4


For Physicians Only


PEP Programs And Resources5


Internet Resources

Several nPEP documents are found on the internet. On most search engines the key words, PEP HIV, will bring up a long list of articles. A few include:


Footnotes

  1. It cannot be concluded that nPEP is not effective when started after 72 hours. Data suggests that the earlier the intervention is started the greater the chances of success. Currently there's no definite time after exposure that nPEP is deemed useless. If the risk of the exposure is very high, it may be reasonable to start nPEP even after 72 hours.

  2. If the woman is pregnant, it's important that both you and she are aware of study results that show the effectiveness of preventing HIV transmission from mother to child. Research centers like the Bay Area Perinatal AIDS Cohort (BAPAC) in San Francisco have reduced mother-to-child transmission rates to near zero. For more information, call the National Perinatal HIV Consultation and Referral Service (www.ucsf.edu) at 1-888-448-8765 (available 24/7).

  3. People may be under a great deal of stress and may not be able to retain information that's provided to them. Consider using starter packs of medication (3-5 days). Schedule a follow-up visit to review lab results and provide counseling, support and medication adjustment, as needed.

  4. For a more complete listing of HIV treatment information and other resources, read Resource Guide.

  5. Please help Project Inform keep this resource list up to date. If you discover a site or clinic in your local area that provides nPEP, please let us know the name of the clinic and/or a contact person. Call 415-558-8669 x212 or email web@projectinform.org.




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