HIV Post-Exposure Prophylaxis (PEP) Information for Travellers
- What is my risk of acquiring HIV in an occupational setting?
- What can I do to reduce risk?
- How can I get PEP before I travel?
- What is PEP?
- When should I start PEP?
- How long is a course of PEP?
- How should I take the tablets?
- What are the side-effects of the tablets?
- Are there interactions with other drugs?
- Taking PEP During Travel
Those with a possible occupational risk of HIV infection may consider taking PEP with them when they travel.
What is my risk of acquiring HIV in an occupational setting?
The risk of acquiring HIV following a percutaneous injury is small (about 3 in 1000). The risk is increased in the following situations:
- A needlestick injury with a wide bore needle
- more extensive injury in the presence of HIV-infected blood (e.g. a scalpel injury during an surgical procedure)
- if the source patient has a high HIV viral load.
Infection can also occur as a result of exposure of intact mucous membranes to HIV-infected blood but there have been no reported cases of infection following exposure of intact skin.
What can I do to reduce risk?
- Prevent avoidable exposure by following procedures regarding safe handling and disposal of needles and wearing protective eyewear, gloves and clothing as appropriate.
- Wash the site of exposure immediately with soap and water, without scrubbing. Free bleeding of puncture wounds should be encouraged. Exposed mucous membranes, including eyes, should be irrigated with copious amounts or water.
- Consider PEP using antiretroviral medication.
- If you are a medical, nursing or dental student travelling for an elective abroad, procedures considered beyond your level of competence in the U.K. should not be carried out while you are in another country. Ensure that your travel insurance covers the medical/dental activities you intend to carry out on your elective but be aware that it may not cover you for expenses incurred following a potential HIV exposure if you are carrying out inappropriate activities.
How can I get PEP before I travel?
PEP must be prescribed by a doctor and should be discussed with a Travel Health Advisor with experience in this area, well before departure.
You should discuss the following:
- Your past medical history - some drugs used in PEP may be contraindicated in certain medical conditions.
- Possible interactions with other medication, including the oral contraceptive pill.
- Side effects of PEP.
- How to risk-assess whether an injury may have put you at risk of infection.
What is PEP?
PEP consists of at least three antiretroviral drugs used together. United Kingdom guidelines recommend the following:
Tenofovir/Emtricitabine (200/245mg) 1 tablet once daily
Raltegravir® 400 mg twice a day
Tenofovir/Emtricitabine is a combination tablet. Generic versions of this combination are now available in the UK from a variety of manufacturers. The non-generic form is known as Truvada® .
PEP is not a licensed indication for any of the antiretroviral drugs, which are therefore prescribed on an 'off-label' basis in the context of PEP.
PEP is not the same as, and should not be confused with PrEP. PrEP (pre-exposure prophylaxis) is used to prevent sexual transmission of HIV infection. There is no evidence that PrEP prevents HIV transmission from percutaneous exposure in an occupational setting.
When should I start PEP?
Treatment should be started as soon as possible after exposure (preferably within one hour) but may still be effective if started up to 72 hours after exposure.
You should seek medical advice immediately after starting PEP to arrange follow-up. You will also need to discuss HIV testing of the source patient with their doctor.
How long is a course of PEP?
PEP is usually taken for 4 weeks. It is important that all tablets are taken according to instructions, no tablets are missed and PEP is not discontinued without expert advice.
How should I take the tablets?
Take one Tenofovir/Emtricitabine tablet with one 400mg Raltegravir tablet at the same time every day, and take the second 400mg Raltegravir tablet 12 hours later.
What are the side-effects of the tablets?
Before taking PEP you should be familiar with the side effects. Consult the British National Formulary (BNF) or Summary of Product Characteristics (SPC).
Are there interactions with other drugs?
There are possible interactions between antiretrovirals and other medication. Drug interactions should be considered before commencing PEP. Drug Interactions with antiretroviral regimes can be checked on the University of Liverpool HIV Drug Interactions website
Taking PEP During Travel
PEP should be taken for 28 days after a potential exposure. PEP packs given to travellers for use if an exposure occurs usually contain 5 days of medication. This is to allow you time to commence the regime and make plans to return to the UK. On return to the UK you should contact your occupational health department or infectious diseases team; they will arrange for the next 23 days of medication to be dispensed and for ongoing follow up, testing and counselling support.
NOTE: Raltegravir and/or Tenofovir/Emtricitabine may not be available in resource poor countries. If you do not intend to return to the UK after commencing PEP, you must check prior to travel which antiretroviral drugs are available at the destination. Consider taking an alternative regime such as Combivir® (300mg zidovudine, 150mg lamivudine) twice daily PLUS Kaletra® (200mg lopinavir and 50mg ritonavir in a combined tablet) twice a day, that is more likely to be available,. This regime is as effective but has a higher risk of side effects.