A family nurse practitioner in a multispecialty clinic in the Midwest called the PEPline regarding her 28-year old female patient who had condomless vaginal intercourse the night before with a non-mutually monogamous man of unknown HIV status. The partner has repeatedly declined HIV testing, and the patient’s last negative HIV test was more than a year ago. The patient takes fluoxetine for depression, and has no other medical conditions. The caller asked whether post-exposure prophylaxis (PEP) is warranted.
The PEPline consultant advised rapid HIV testing of the patient to make sure she is not currently HIV-positive, as she has had ongoing risk activities since her last negative HIV test. If she remains HIVnegative, she should be offered post-exposure prophylaxis (PEP) (given her partner’s unknown HIV status and other sex partners) and counseled on the potential risks and benefits of PEP. This would include a discussion of per-act transmission risk, effectiveness of PEP, and potential side effects. If she opts to start PEP, she should take the first dose as soon as possible and remain adherent to the complete regimen throughout the 28-day course of medications. The PEP consultant also stressed the importance of follow-up lab testing, which would include retesting for HIV, hepatitis B and C, and other STIs. The PEPline consultant also advised the caller that it would be important to discuss pre-exposure prophylaxis (PrEP) as an additional HIV prevention option upon completion of PEP. The caller had never prescribed PrEP, so the consultant discussed how to determine PrEP eligibility, what baseline laboratory testing is recommended, and how to prescribe PrEP. The consultant offered the NCCC’s PrEPline number as an additional clinical decision-making/educational resource.