Non-occupational post exposure prevention

When you think you were exposed to HIV within the past three days

January 2009     View PDF     En español

If you are reading this because you’ve had a possible exposure to HIV within the last 72 hours and you are considering nPEP, call your doctor, an nPEP study site or other resources (like a hospital emergency room), immediately. Take this paper to your doctor and use the insert, Talking to Your Doctor, to help you both in making decisions.

If it has already been longer than 72 hours since your exposure, nPEP is not a viable option for you. If you have waited longer than 72 hours before starting nPEP, there’s little chance that the treatments will be able to block the establishment of HIV infection. In this case, seek out information about your HIV screening options (read Project Inform’s publication, Ways to Test for HIV) and seek HIV prevention and risk reduction counseling. Even if you have had a possible HIV exposure, you might not be infected. HIV screening is the only way you will be able to know if you have become infected.

Post Exposure Prophylaxis (PEP) is starting HIV drugs within 72 hours (three days) of a suspected exposure to HIV, the virus that causes AIDS. The goal of PEP is to prevent the establishment of HIV infection in a person recently exposed to the virus. PEP is not appropriate, and may be harmful, for people with early or established HIV infection. Ideally, whenever PEP is considered or undertaken, it should be coupled with counseling about HIV risk, prevention and screening.

PEP programs for exposures to HIV during sex or injection drug use are open in a few centers in the US. (These are called non-occupational exposures; see the box on page 2. This publication refers to these exposures as nPEP.) Through these programs, people who believe they might have been exposed to HIV can talk with a doctor to assess their risk for HIV infection. If their risk is high, they will be offered HIV therapy (two or three drugs) after discussing the risks and potential benefits of therapy. If they choose to take therapy, they will be encouraged to take the drugs for about a month. People who participate in nPEP studies are usually given the drugs and lab testing for free.

An individual does not have to participate in a study in order to use HIV therapy in this situation. However, insurance companies and other health care reimbursement programs, like Medicaid or MediCal, may not pay for its cost and related lab work for someone who has not been shown to actually have HIV infection.

Currently, using PEP for sexual or injection drug use HIV exposure is considered experimental and has not been proven to block the establishment of HIV infection in people, even when used within 72 hours. There is some evidence that it can block infection from what are called “occupational” exposures. This is when a health care worker is stuck by a needle that has had contact with HIV, or has a cut or abrasion that makes contact with HIV-infected blood.