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## Complete Summary

#### GUIDELINE TITLE

UK guideline for the use of post-exposure prophylaxis for HIV following
sexual exposure.

#### BIBLIOGRAPHIC SOURCE(S)

Fisher M, Benn P, Evans B, Pozniak A, Jones M, Maclean S, Davidson O,
Summerside J, Hawkins D, Clinical Effectiveness Group (British
Association for Sexual Health and HIV). UK guideline for the use of
post-exposure prophylaxis for HIV following sexual exposure. Int J STD
AIDS 2006 Feb;17(2):81-92. \[84 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16464267)

#### GUIDELINE STATUS

This is the current release of the guideline.

### \*\* REGULATORY ALERT \*\*

#### FDA WARNING/REGULATORY ALERT

**Note from the National Guideline Clearinghouse**: This guideline
references a drug(s) for which important revised regulatory and/or
warning information has been released.

-   [September 10, 2007, Viracept (nelfinavir
    mesylate)](http://www.fda.gov/medwatch/safety/2007/safety07.htm#Viracept):
    Pfizer issued a Dear Healthcare Professional Letter to inform
    healthcare professionals of the presence of ethyl methanesulfonate
    (EMS), a process-related impurity in Viracept and to provide
    guidance on the use of Viracept in pregnant women and pediatric
    patients.

### COMPLETE SUMMARY CONTENT

 \*\* REGULATORY ALERT \*\*\
 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Human immunodeficiency virus (HIV) infection

#### GUIDELINE CATEGORY

Counseling\
Evaluation\
Management\
Prevention\
Risk Assessment

#### CLINICAL SPECIALTY

Allergy and Immunology\
Emergency Medicine\
Family Practice\
Infectious Diseases\
Internal Medicine\
Preventive Medicine

#### INTENDED USERS

Advanced Practice Nurses\
Nurses\
Physician Assistants\
Physicians\
Psychologists/Non-physician Behavioral Health Clinicians\
Public Health Departments\
Social Workers

#### GUIDELINE OBJECTIVE(S)

To ensure the appropriate use of post-exposure prophylaxis (PEP)
following potential sexual exposure (PEPSE) to human immunodeficiency
virus (HIV) as a potential method of preventing HIV infection

#### TARGET POPULATION

Patients at risk for human immunodeficiency virus (HIV) infection due to
sexual exposure to HIV

#### INTERVENTIONS AND PRACTICES CONSIDERED

1.  Risk assessment to determine whether post-exposure prophylaxis (PEP)
    following potential sexual exposure (PEPSE) is appropriate

2.  PEPSE regimens implemented as soon as possible after the exposure

    -   Triple agent regimens that may use nucleoside reverse
        transcriptase inhibitors (NRTIs), non-nucleoside reverse
        transcriptase inhibitors (NNRTIs), and protease inhibitors
        (PIs).

    -   Modification of PEP antiretroviral therapy in relation to drug
        history or resistance testing, if available, in patients with
        current or past history of treatment failure

3.  Management of treatment side-effects

4.  HIV testing prior to and shortly after initiation of PEPSE and at
    three and six months

5.  Referral to a Health Advisor (or appropriately experienced health
    care worker)

6.  Regular medical follow-up and patient encouragement

7.  Comprehensive screening for other sexually transmitted diseases
    (STIs)

8.  Consideration of Hepatitis B vaccination (and immunoglobulin)

9.  Risk reduction counseling

10. Counseling of repeat users of PEPSE

#### MAJOR OUTCOMES CONSIDERED

-   Transmission of HIV infection

-   HIV seroconversion

-   Efficacy of post-exposure prophylaxis (PEP)

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

Not stated

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Expert Consensus

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

The development of this guideline included a writing group with
representatives from British Association for Sexual Health and HIV
(BASHH), British HIV Association (BHIVA), Expert Advisory Group on AIDS
(EAGA), Society of Sexual Health Advisers (SSHA), Health Protection
Agency (HPA), the HIV and Sexual Health Group of the British
Psychological Association, the Terrence Higgins Trust (THT) and the
National AIDS Trust (NAT). Patients\' perspectives were considered by
involvement of THT, NAT and discussion at a stakeholder group organized
by THT and the Community HIV and AIDS Prevention Strategy (CHAPS)
conference.

The guideline is based upon a comprehensive review of the literature
pertaining to post-exposure prophylaxis (PEP) following potential sexual
exposure (PEPSE). The recommendations are based upon a combination of
biological plausibility, cohort studies, data from PEP in other
settings, and expert opinion. The recommendations are the result of a
series of meetings of the writing committee and the input from the
consultation process.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

There is no conclusive data regarding the cost effectiveness of
post-exposure prophylaxis (PEP) following potential sexual exposure
(PEPSE). It has been argued that the cost of providing PEP may be
effectively spent on other prevention initiatives. However, while the
drug cost of a full 28-day course of PEP is approximately 600 pounds
sterling, the lifetime costs of treatment for an HIV positive individual
are estimated to be between135,000 and 181,000 pounds sterling. A
retrospective cost analysis of the San Francisco PEPSE programme has
shown it to be cost-effective when used in high-risk exposures and
potentially cost saving when used after receptive anal intercourse in
men who have sex with men (MSM). Subsequent modelling utilizing data
from many United States cities suggests similar levels of
cost-effectiveness providing PEPSE is targeted to high-risk exposures
consistent with those recommended within these guidelines.

#### METHOD OF GUIDELINE VALIDATION

External Peer Review\
Internal Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Prior to publication the final draft was placed on the British
Association for Sexual Health and HIV (BASHH) website and copies
circulated to the Terrence Higgins Trust (THT), the British HIV
Association (BHIVA), and the Department of Health for comment and peer
review. After a period of 12 months, any comments received were reviewed
by the guideline authors, and acted upon appropriately, before final
authorization by the Clinical Effectiveness Group (CEG) was given and
publication was undertaken.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

**[Recommendations for Prescribing Post-Exposure Prophylaxis (PEP)
Following Potential Sexual Exposure (PEPSE)]{.underline}**

It is crucial to consider PEPSE as only one strategy in preventing human
immunodeficiency virus (HIV) infection and, as such, it should be
considered as a last measure where conventional, and proven, methods of
HIV prevention have failed.

A risk versus benefit analysis should be undertaken for every individual
presenting following an exposure and the decision to initiate PEP made
on a case-by-case basis. This should consider both the risk of
transmission according to coital act (as in Table 2 in the original
guideline document) and the risk of the source being HIV positive (as in
the Table 1 in the original guideline document). Consideration should be
given to the possibility of the presenting individual having already
been infected with HIV, and the ability to adhere to and tolerate the
proposed antiretroviral drug regimen. The potential exposure to other
sexually transmitted infections (STIs) and appropriate management for
this needs to be considered alongside consideration of provision of
PEPSE. The wishes of the individual should be considered at all times.

**Situations in which PEPSE Would Be Considered**

The use of PEPSE following potential sexual exposure to HIV is only
recommended where the individual presents within 72 hours of exposure.
Within that time frame, it is recommended that PEPSE (if given) should
be administered as early as possible. All recommendations are for either
unprotected sexual exposure or where condom failure has occurred.
Recommendations regarding fellatio are where the partner giving fellatio
is presenting for PEPSE.

*Source Individual Is Known to Be HIV Positive*

  ----------------------------------------- -----------------------------
  Receptive anal sex                        Recommended

  Insertive anal sex                        Recommended

  Receptive vaginal sex                     Recommended

  Insertive vaginal sex                     Recommended

  Fellatio with ejaculation                 Considered

  Splash of semen into eye                  Considered

  Fellatio without ejaculation              Not recommended

  Cunnilingus                               Not recommended
  ----------------------------------------- -----------------------------

*Source Individual Is of Unknown Status*

Attempt should be made, where possible, to establish the HIV status of
the source individual (according to appropriate guidance on HIV testing
and consent) as early as possible. There is growing evidence to suggest
that significant cases of PEP can be averted through assertive HIV
testing of the source individual. It is therefore recommended that
strong efforts be made to encourage the individual to notify their
partner where possible, and for the clinic to arrange urgent HIV testing
of that partner, with appropriate guidance on HIV testing and consent,
as early as possible.

*Source Is from a Group or Area of High HIV Prevalence*

  ------------------------------------------- ---------------------------
  Receptive anal sex                          Recommended

  Insertive anal sex                          Considered

  Receptive vaginal sex                       Considered

  Insertive vaginal sex                       Considered

  Fellatio with ejaculation                   Considered
  ------------------------------------------- ---------------------------

*Source Is Not from a Group or Area of High HIV Prevalence*

  --------------------------------------- -------------------------------
  Receptive anal sex                      Considered

  Insertive anal sex                      Not recommended

  Receptive vaginal sex                   Not recommended

  Insertive vaginal sex                   Not recommended

  Fellatio with ejaculation               Not recommended
  --------------------------------------- -------------------------------

High prevalence groups within this recommendation are those where there
is a significant likelihood of the source individual being HIV positive.
Within the United Kingdom (UK) at present, this is likely to be men who
have sex with men (MSM) and individuals who have immigrated to the UK
from areas of high HIV prevalence (particularly sub-Saharan Africa).

*Sexual assault*: It is believed that transmission of HIV is likely to
be increased following aggravated sexual intercourse (anal or vaginal),
such as that experienced during sexual assault. Clinicians may therefore
consider recommending PEPSE more readily in such situations. While the
routine recommendation of PEPSE is likely to be appropriate in high
prevalence situations, it is likely that the strength of recommendation
and subsequent uptake will be lower in UK settings unless the \'donor\'
is perceived to be from a high-prevalence group.

*Other factors which may alter the strength of recommendation*: Where
factors are present which are believed to influence the probability of
HIV transmission - presence of concurrent sexually transmitted infection
(STI), knowledge of viral load in the \'donor\' - the strength of these
recommendations may be increased or decreased appropriately.

**Recommendations for Drug Regimens to Be Used**

The choice of drugs to be used for PEP is drawn from those used in
established infection. These include the nucleoside reverse
transcriptase inhibitors (NRTIs), the non-nucleoside reverse
transcriptase inhibitors (NNRTIs) and the protease inhibitors (PIs). In
addition the nucleotide tenofovir has shown activity as PEP in an animal
(simian immunodeficiency virus \[SIV\]/macaque) model of sexual exposure
and is currently being evaluated in high-risk populations as monotherapy
for pre-exposure prophylaxis. Other classes of drugs such as entry
inhibitors (T20) will need to be considered as they become available for
established infection. Zidovudine (an NRTI) is the only drug to date
which has been studied and for which there is evidence of reduction of
risk of HIV transmission following occupational exposure. It is for this
reason that many consider it to be reasonable that zidovudine is
included in all first choice PEP regimens, unless there is evidence that
the source virus is resistant to this drug, or that there is significant
intolerance. However, it is theoretically likely that alternative
nucleosides will be equally effective. Some recent studies suggest that
a tenofovir-containing regimen may be better tolerated than zidovudine;
therefore, it would be reasonable to offer this as an alternative either
at initial presentation or if zidovudine-related side-effects occur.

In established HIV infection, combination drug therapy with at least
three drugs is more effective than monotherapy or dual drug regimens. It
is thus recommended, when there is considered to be a significant risk
of HIV transmission following risk assessment, that a triple agent
regimen be advised. Theoretical considerations to support the
recommendation of three drugs include the later presentation of patients
for PEPSE and giving drugs with different resistance patterns as any
resistant virus in the source may be unknown.

Nevirapine is not recommended due to the high rates of hepatotoxicity
and potential for fulminant hepatic failure when used in this setting.
Efavirenz has a lower incidence and severity of rash, but this reaction
may still cause anxiety and diagnostic confusion. Furthermore efavirenz
causes short-term psychostimulation, which is possibly less well
tolerated in anxious patients receiving PEP than in patients with
established HIV infection.

The routine use of abacavir is also not recommended. A hypersensitivity
reaction is reported in up to 8% of patients with established infection.
Although the risk has not been assessed in HIV negative individuals, it
is recommended to reserve the use of abacavir for when first-line
treatments are not thought appropriate.

It is recommended that the choice of antiretroviral regimen prescribed
should follow consideration of local epidemiology of drug resistance,
particularly the incidence of primary resistance which may be increasing
in some parts of the UK.

Individuals who are already well informed regarding the safety,
tolerability and efficacy profiles of individual antiretroviral agents
may have their own individual perspective on which agents they would
prefer to rake. Such choices should, where possible, be respected but
may be affected by the composition of \'starter packs\', the possible
resistance \'history\' of the donor, local HIV primary resistance rates,
and must involve consideration of toxicity profiles in the uninfected.

*Recommended Combinations*

2NRT1^\#^ + PI\* (boosted PI^+^)

\* - Nelfinavir

\+ - Lopinavir or fosamprenavir or saquinavir

\# - (azidothymidine \[AZT\] & epivir \[3TC\]) or (stavudine \[D4T\] &
3TC) or (tenofovir & 3TC) or (tenofovir & emtricitabine \[FTC\])

Other triple combinations in use for established infection may also be
considered reasonable choices and a number are currently being evaluated
in international studies.

If there is evidence that the source patient has current or past history
of treatment failure, the PEP antiretroviral therapy should be modified
in relation to the drug history and/or to resistance testing if
available. Expert advice should be sought.

**Starter packs** As with the guidelines for occupational exposure, it
may be helpful to use a starter pack (3 to 5 days medication). Should
PEP starter packs be used, suitable combinations would be Combivir®
(zidovudine 300 mg plus lamivudine 150 mg) twice daily (bd) plus
nelfinavir 1250 mg bd. An alternative to Combivir would be Truvada®
(tenofovir 245 mg plus emtricitabine 200 mg). An alternative to
nelfinavir would be a boosted PI such as lopinavir/ritonavir 3 capsules
bd or fosamprenavir 700 mg bd with ritonavir 100 mg bd (or 1400 mg once
daily \[od\] with ritonavir 200 mg od). The need for refrigeration of
ritonavir and Kaletra® may inhibit their use as starter packs; an
alternative strategy may be to switch to one of these agents after
expert review.

This PEPSE regimen can be continued or modified at initial review within
five days, depending on further information about the source virus and
the patient\'s tolerance of the medication.

**Side-effects** Any of the antiretroviral drugs may have side effects,
which appear to be less well tolerated in HIV-negative patients
receiving PEP than HIV-positive individuals starting treatment. Many of
these can be managed symptomatically, for example the use of
anti-nauseants and antidiarrhoeals with the combination of Combivir and
nelfinavir. Close monitoring and follow-up of individuals receiving
PEPSE is recommended to manage such side effects and thereby optimize
completion rates.

**Duration of treatment** The optimal duration of PEP is unknown.
However, animal studies and a case-controlled study of health care
workers suggest that four weeks is required to minimize the potential
for HIV transmission. It is recommended therefore that four weeks of PEP
should be utilized in the sexual exposure setting (unless source-testing
after initiation of PEPSE determines that the \'donor\' is
HIV-negative).

**Service Provision to Enable Appropriate Use of PEPSE**

Given that, for optimal efficacy, PEPSE should be commenced as soon as
possible after exposure, 24-hour access should be available. As with PEP
following occupational exposure, it is recommended that local policies
and pathways be established to enable this.

It is therefore likely that accident & emergency (A&E) departments will
be expected to assume significant responsibility for provision of PEPSE,
with the need for support and training from areas of local expertise.
Such areas are likely to be Departments of Genitourinary (GU) Medicine,
HIV Medicine, Infectious Diseases or Virology/Microbiology. The training
issues are essentially those outlined comprehensively in the Department
of Health/Expert Advisory Group (DH/EAGA) on acquired immunodeficiency
syndrome (AIDS) guidance on HIV PEP.

It is recommended that individuals presenting for PEPSE should be
referred and seen as early as possible by a clinician experienced in the
management of antiretroviral therapy and with expertise in HIV testing
and transmission - whether or not PEPSE is offered or accepted. PEPSE
should not be withheld until such expertise is available. However, it is
recommended that local policies should include 24-hour access to advice
from an experienced HIV clinician, particularly for cases where the
PEPSE regimen may need to be adjusted to reflect possible drug
resistance in the \'donor\'.

**Assessment and Initial Management of the Individual Presenting for
PEPSE**

It is essential that an appropriate risk assessment is performed to
enable provision of PEPSE according to the recommendations outlined
above.

At presentation, and prior to administration of PEPSE, the following
issues must be discussed with the individual:

-   The rationale for PEPSE

-   The lack of conclusive data for the efficacy of PEPSE

-   The potential risks and side effects of PEPSE

-   The arrangement for early follow-up with an HIV/genitourinary
    medicine (GUM) clinician

The use of a consent form is not considered essential, but documentation
must demonstrate that these issues have been discussed.

It is mandatory that individuals for whom PEPSE is provided to undertake
an HIV test (with rapid result) prior to, or shortly after initiating
therapy. This recommendation reflects the possibility of undiagnosed HIV
infection, which would significantly alter the risk-benefit balance of
short-course antiretroviral therapy. It may be possible for service
providers to obtain results more rapidly by considering newer
technologies, such as saliva testing or rapid serum HIV testing.
However, such testing should follow the conventional norms of informed
consent.

Those presenting for PEPSE must be seen in a GU Medicine/HIV department
at the earliest opportunity. It is recommended that the individual be
referred to a Health Adviser (or appropriately experienced health care
worker), where the following issues can be addressed:

-   Pre-test discussion (if HIV status as yet unknown)

-   The need to continue with a further four-week course of PEPSE if the
    baseline result is negative

-   The need to have a follow-up HIV test at three and six months

-   The side effects of the drugs and the support available in the
    clinic and in the community to help adherence

-   The need to utilize generic social support over the following three
    to six months

-   The need for safer sex for the following six months

-   Issues around disclosure

-   Coping strategies

-   For patients concerned about sexual risk taking health advisers can
    offer ongoing risk reduction work or referral to psychology if
    appropriate

**Follow-Up Arrangements for Individuals Presenting for PEPSE**

Regular medical follow-up is necessary for individuals receiving PEPSE
to monitor tolerability and possible toxicity of the medications. Close
follow-up and encouragement, ideally on a weekly basis at first, is
likely to improve adherence to the treatment regimen and allow prompt
management of any concerns or complications.

It is recommended that all individuals who receive PEPSE (and those who
decline but have had significant risk of exposure to HIV) be re-tested
for HIV antibodies at three and six months.

At present there is no prospective monitoring scheme for individuals
receiving PEPSE, but it is anticipated this may be developed in
conjunction with the Health Protection Agency.

Any adverse events attributed to antiretroviral medications should be
reported via the HIV Adverse Drug Reactions Reporting Scheme.

**Additional Management of Individuals after Potential Sexual Exposure
to HIV**

It is recommended that all individuals presenting for PEPSE be
comprehensively screened for other STIs at an appropriate time point, in
accordance with the guidelines on screening for STIs (accessible at
\[www.bashh.org\]). It is essential that Hepatitis B vaccination (and
immunoglobulin) be considered in addition to PEP in accordance with
existing guidance. Additionally, the opportunity should be taken for
appropriate risk-reduction discussion with individuals presenting for
PEPSE.

**[Other Issues Relating to Sexual Exposure to HIV]{.underline}**

**Dissemination of Information Regarding PEPSE to Individuals Who May Be
At Risk of HIV Transmission**

It is recommended that information regarding PEPSE should be proactively
provided to individuals diagnosed with HIV infection, particularly if in
a serodiscordant relationship. Furthermore, uninfected individuals with
potential for future exposure to HIV, should be provided with
information regarding PEPSE in addition to full discussion of other
proven risk-reduction strategies. It is recognized that community-based
organizations will have a large part to play in providing this
information. Consideration should be given to provision of 24-hour
helpline access to enable individuals to establish whether presentation
to hospital services for PEPSE is appropriate.

**Management of Individuals Who Repeatedly Present for PEPSE or with
Ongoing Risk Behaviour**

There is also a concern regarding repeat users of PEPSE. However, once
again, there is no data suggesting that a significant number of
individuals will utilize PEPSE repeatedly, perhaps due to the aversive
nature of the medications. It is therefore recommended that individuals
be considered for repeat courses of PEPSE according to the risk of HIV
acquisition at the time of presentation, particularly if their
circumstances suggest this to be appropriate (commercial sex workers,
serodiscordant couples, inability to control the preventative behaviour
of their partners). However, it is also recommended that repeat
attenders be strongly encouraged to discuss these issues with a Health
Advisor and/or Psychologist.

Individuals who present more than once a year for PEPSE, who do not
otherwise have prevailing circumstances for doing so, are of greater
concern and should be referred at an early stage for discussions around
their safer sex strategies. They should still be considered for PEPSE if
the current risk circumstances clearly indicate a need for this, but
that this is conditional on their attendance for discussions around
future safer sex strategies.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence supporting the recommendations is not specifically
stated for each recommendation.  In general, the recommendations are
based upon a combination of biological plausibility, cohort studies,
data from  post-exposure prophylaxis (PEP) in other settings, and expert
opinion.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Reduced transmission of human immunodeficiency virus (HIV) following
sexual exposure to HIV

#### POTENTIAL HARMS

**Side Effects of Antiretroviral Drugs**

Any of the antiretroviral drugs may have side effects, which appear to
be less well tolerated in human immunodeficiency virus (HIV)-negative
patients receiving post-exposure prophylaxis than HIV-positive
individuals starting treatment.

**Specific Side Effects of Protease Inhibitors**

-   Metabolic abnormalities

-   Lipid abnormalities

-   Insulin Resistance

-   Diabetes mellitus

-   Gastro-intestinal side effects

**Other**

Poor adherence of PEP regimens theoretically may result in the
acquisition of a drug-resistant virus, should the individual become
HIV-infected. This has been suggested as a risk for subsequent
seroconversion in a retrospective analysis of post-exposure prophylaxis
following potential sexual exposure (PEPSE) failures.

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

The recommendations in this guideline may not be appropriate for use in
all clinical situations. Decisions to follow these recommendations must
be based on the professional judgment of the clinician and consideration
of individual patient circumstances and wishes. It should be
acknowledged that use of any antiretroviral agent in this setting is an
unlicensed indication. All possible care has been undertaken to ensure
the publication of the correct dosage and route of administration.
However, it remains the responsibility of the prescribing physician to
ensure the accuracy and appropriateness of the medication they
prescribe.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

The provision of post-exposure prophylaxis (PEP) following sexual
exposure requires consideration of appropriate pathways of care between
genitourinary medicine/human immunodeficiency virus (HIV) clinicians and
those providing access to emergency and primary care in order to ensure
post-exposure prophylaxis following potential sexual exposure (PEPSE) is
administered both appropriately and in a timely fashion. This will
require local interpretation of this guideline and will most likely
involve a degree of organizational change and provision of additional
resources.

#### IMPLEMENTATION TOOLS

Audit Criteria/Indicators\
Chart Documentation/Checklists/Forms

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Staying Healthy

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Fisher M, Benn P, Evans B, Pozniak A, Jones M, Maclean S, Davidson O,
Summerside J, Hawkins D, Clinical Effectiveness Group (British
Association for Sexual Health and HIV). UK guideline for the use of
post-exposure prophylaxis for HIV following sexual exposure. Int J STD
AIDS 2006 Feb;17(2):81-92. \[84 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16464267)

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2006 Feb

#### GUIDELINE DEVELOPER(S)

British Association for Sexual Health and HIV - Medical Specialty
Society

#### SOURCE(S) OF FUNDING

No specific or external funding was sought or provided in the
development of this guideline.

#### GUIDELINE COMMITTEE

Clinical Effectiveness Group

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Author*: Martin Fisher; Paul Benn; Barry Evans; Anton Pozniak; Mike
Jones; Suzie MacLean; Oliver Davidson; Jack Summerside

*Clinical Effectiveness Group (CEG) Members*: Keith Radcliffe
(*Chairman*), Imytaz Ahmed-Jushuf; Mark Fitzgerald; Guy Rooney; Jan
Welch

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [British Association for Sexual
Health and HIV Web site](http://www.bashh.org/documents/58/58.pdf).

#### AVAILABILITY OF COMPANION DOCUMENTS

Auditable outcome measures and example of potential sexual exposure
(PEPSE) proforma are provided in the [original guideline
document](http://www.bashh.org/documents/58/58.pdf).

#### PATIENT RESOURCES

None available

#### NGC STATUS

This NGC summary was completed by ECRI Institute on June 9, 2008. The
information was verified by the guideline developer on August 13, 2008.

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to
the guideline developers and/or BMJ Publishing Group\'s copyright
restrictions. Reproduction and use of this guideline is permitted
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that of the author(s) and responsible organizations.

Readers wishing to download and reproduce material for purposes other
than personal study or education should contact BMJ Publishing Group to
seek permission first at <http://www.bmjjournals.com/misc/perm1.shtml>.

### DISCLAIMER

#### NGC DISCLAIMER

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Date Modified: 11/10/2008