Management of non-occupational exposure to HIV in emergency departments
This procedure is intended to facilitate the management of incidents involving potential exposure to HIV
infection in the non-occupational context, ensuring compliance with the:
Post-Exposure Prophylaxis after Non-Occupational and Occupational exposure to HIV: Australian
National Guidelines (Second edition), (2016)
The decision to initiate (or not) non-occupational post-exposure prophylaxis (NPEP) and the
baseline procedures required are guided by the flow charts in this document. The
Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) and the
Committee for these Guidelines strongly recommend that reference also be made to the
National Guidelines before any decision to initiate NPEP in ED
www.pep.guidelines.org.au
Algorithm for management of NPEP for HIV in an emergency department
Potential exposure to HIV
Emergency response – TRIAGE 3
Establish eligibility for HIV NPEP using the risk assessment flowchart
and
pp. 6-8 of the Guidelines
Prior to prescribing NPEP, consult with the ED Staff Specialist and consider consultation with the
on-call Infectious Diseases Consultant or Sexual Health Physician particularly if the patient is:
pregnant or breast feeding
has significant medical co-morbidities, in particular compromised renal function
Call <number> and ask for the on-call specialist to be paged.
No NPEP
Yes
prescribed?
Provide prevention Provide a 7-day NPEP starter pack (located in <the
information after-hours medication cupboard - both two-drug and
HIV, STI and BBV three-drug regimens are available>) along with
education about potential side-effects and medication
adherence
Conduct baseline testing p.13 of the Guidelines.
Copy the baseline testing results to the GP or centre
Refer to local GP or Sexual Health Provide prevention information
Clinic for STI and BBV screening on HIV, STI and BBV
NPEP prescribed?
Refer for ongoing management (within 7 days) to local
No sexual health services
Document follow up arrangements
Refer: Provide patient with referral letter and information sheet
To local sexual health clinic See
list of Local Sexual Health
clinics in PEP folder
For crisis intervention
Risk assessment flowchart
CONSIDER NPEP IF CONDITIONS 1, 2 AND 3 ARE MET
1
HIGH RISK EXPOSURE
Condomless receptive intercourse (anal or vaginal)i
Condomless insertive intercourse (anal or vaginal) i
Use of contaminated injecting equipment
i
Condomless means no condom used or condom slippage/breakage.
Notes: Condomless receptive oral intercourse with ejaculation MAY BE CONSIDERED as a high risk exposure
providing the source is known to be HIV-positive with a detectable HIV viral load and there is oral mucosal
disease or an open lesion in the mouth or throat.
Significant exposure of non-intact skin with blood, sperm or vaginal fluids MAY ALSO BE CONSIDERED as a
high risk exposure providing the source is known to be HIV positive with a detectable HIV viral load.
Source is known to be HIV infectedii
OR
Source is likely to be at increased risk of HIV
Men who have sex with men
Heterosexual person who injects drugs
A person from a high HIV prevalence country (HIV prevalence > 1.0%)iii
A sex worker OUTSIDE of Australia
ii
NPEP is NOT RECOMMENDED following insertive/receptive anal, vaginal or oral sex, sharing of needles or
other injecting equipment, and mucous membrane and non-intact skin exposure when the source viral load is
KNOWN to be undetectable – this is provided the source is known to be compliant with medication, attends
regular follow-up and has no intercurrent STI.
iii
Data available at: http://aidsinfo.unaids.org/
3
The patient presents within 72 hours of exposure
1 + 2 + 3 = NPEP
