AIDS/HIV

After transitioning from a PEP starter pack to the full 28 days of treatment, patients are typically seen again after two weeks in primary care or HIV clinic, where they are evaluated for medication toxicity and adherence. They should be seen again 4-6 weeks after PEP initiation to repeat screening for HIV and STI, and for pregnancy testing if relevant. Attrition rates between the emergency department and clinics are high. 15 We find it useful for patients to identify and designate a friend or relative at the first point of contact to help ensure the patient follows up in clinic and to assist with drug adherence. We also find it helpful to confirm a patient contact information, and we will repeatedly attempt to contact patients should they miss an appointment to facilitate timely follow-up and completion of the recommended course of therapy and follow-up testing schedule. HIV testing is repeated four months after the inciting exposure to confirm transmission did not occur at the time of exposure. Perform an additional HIV screen at six months if hepatitis C was acquired from the inciting exposure, as acute hepatitis C infection may delay HIV seroconversion. 1 2 5 PEP may be discontinued early if there is evidence of a negative HIV test or confirmation of a recent undetectable HIV-1 RNA viral load in the source patient (and there is no suspicion that the source has acute HIV infection). Patients with ongoing risk factors for HIV acquisition should be considered for HIV pre-exposure prophylaxis. If seroconversion occurs, refer patients to an HIV treatment provider for immediate initiation of antiretroviral therapy.