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In the Treatment as Prevention session Thursday 17 Nov John McAllister, HIV CNC at ST Vincent Hospital Sydney, presented a 5 min rapid fire overview of his poster "Post-Exposure Prophylaxis for HIV: What else to consider.
The 2016 PEP Guidelines were updated by an expert reference group taking into account new information on the following:
- TasP for condomless anal sex
- PEP/PrEP interface
- Choice of ARVs for PEP
- 7 vs 28 days at initial presentation
- Some documented negative experiences of those presenting for PEP
- Use of PEP in children
Some of the main changes to the PEP Guidelines are:
- PEP is no longer routinely recommended for any non-occupational exposure where the source is on ARV with a non-detectable viral load (ND VL).The previous PEP Guidelines (2013) recommended PEP for MSM anal intercourse where source VL ND. The change to recommending no PEP for these exposures is based on data showing no HIV transmissions in heterosexual or homosexual couples where source has ND VL.
- Individuals presenting to sexual health clinics or GP s100 prescribers may be given the entire 28 day PEP prescription rather than 7 day starter packs. Those presenting to Emergency Departments may only be provided with starter packs.
- Someone currently taking PrEP, but who has not been sufficiently adherent, and has a high risk exposure within the previous 72 hours should be considered for 3 drug PEP
- Choice of drugs for 2 drug PEP are tenofovir/lamivudine or tenofovir/emtricitabine (Truvada). AZT based regimens are no longer recommended.
- Preferred agents for the 3rd drug are dolutegravir or raltegravir or rilpivirine. The main considerations when choosing are dosing, SE and DDIs
- Individuals re-presenting with an additional exposure while currently on PEP should have the course extended to 28 days post the most recent risk event
- A statement that highlights the importance of a non-judgemental approach by clinicians to individuals presenting for PEP. Judgemental attitudes have been documented to have prevented people presenting for PEP on subsequent occasions of risk.
- Section on prescription of PEP for minors
- The 2016 PEP Guidelines are available at www.pep.guidelines.org.au