Talking to your doctor about nPEP

May 2007     View PDF     En español

Discussion points and comments for discussion

 

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

• If no, nPEP is not a reasonable option. Describe acute infection syndrome to the patient. (Not all seroconverters experience this.) Screen for HIV using standard antibody test in 4–6 weeks. Confirm negative results with follow-up tests in 3 and 6 months. Discuss and develop an HIV prevention plan. *
• If yes, nPEP might be a reasonable option.

STEP TWO:
Are you currently HIV-positive?

• If no, confirm it with an HIV antibody test.
• If unknown, screen with an antibody test.
• If yes, nPEP should NOT be started. Treat HIV disease according to Federal Guidelines, available at www.aidsinfo.nih.gov.

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?

• If low to no risk, nPEP is generally discouraged.
• If moderate risk, nPEP might be considered.
• If high to highest risk, nPEP is a reasonable option.
• If the exposure is not isolated and future incidents are highly likely because of regular high-risk activity, nPEP is generally discouraged according to CDC recommendations.

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

• If low to no risk, nPEP is discouraged regardless of risk assessment.
• If moderate risk, nPEP might be considered if warranted by risk assessment.
• If high to highest risk, nPEP is reasonable if warranted by risk assessment.

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

• If no, describe acute infection syndrome to patient. (Not all seroconverters experience this.) Screen for HIV using standard antibody test in 4–6 weeks. Confirm negative results with follow-up tests in 3 and 6 months. Discuss and develop an HIV prevention plan.
• If yes, consider if nPEP is a desirable option.

* 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.

A few points to consider

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Choosing an nPEP regimen