HIV Post-Exposure Prophylaxis (PEP) Information for Travellers
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 contaminated needlestick 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?
- Do not carry out invasive procedures
- If you are a medical 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.
- 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.
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 four antiretroviral drugs used together. United Kingdom guidelines recommend the following:
- Truvada® (245 mg tenofovir and 200mg emtricitabine (FTC) once daily OR Combivir® (300mg zidovudine, 150mg lamivudine) twice daily.
- Raltegravir® 400 mg twice a day OR Kaletra® (200mg lopinavir and 50mg ritonavir in a combined tablet) twice a day.
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.
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?
The implications of infection are so serious both personally and potentially for future career intentions, that we advise that only a 5 day course is initially prescribed, which will give time to arrange to return home for counselling, follow-up and a further prescription for the full 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 Truvada tablet once daily or one Combivir tablet twice daily, with or without food.
Kaletra should be taken with food, 2 tablets twice daily (every 12 hours).
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).
Antiretroviral drugs may cause nausea. Taking the tablets with food may lessen this. It may be necessary to take anti-emetic tablets to minimise this.
Diarrhoea is a common side-effect with Kaletra. It may help to take an anti-diarrhoeal preparation such as loperamide.
Are there interactions with other drugs?
There are possible interactions between antiretrovirals and other medication. Certain medications should not be prescribed when you are taking protease inhibitors. Discuss this with a doctor if you are currently on any other drug therapy, before you are prescribed PEP.
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