Post-exposure prophylaxis to prevent HIV infection
Joint WHO/ILO guidelines on post-exposure prophylaxis (PEP) to prevent HIV infection
Since the early 1990s, in many countries antiretroviral medicines have been prescribed for post-exposure prophylaxis (PEP) following occupational exposure to the human immunodeficiency virus (HIV). This practice has since been extended to non-occupational situations, primarily for cases of sexual assault.
Increasingly, however, both policy-makers and health care providers have been raising questions about certain aspects of the use of HIV PEP: in particular, about the indications for post-exposure prophylaxis, the most suitable antiretroviral medicines to use and various issues relating to prescribing protocols and clinical management. Awareness of these areas of uncertainty has been further heightened by the expanding availability of antiretroviral therapy in more resource constrained settings and has led to calls for clear operational guidance on providing PEP.
In September 2005, a Joint WHO/ILO expert consultation for the development of policy and guidelines on occupational and non-occupational HIV post-exposure prophylaxis was held in Geneva. The objectives of this consultation were:
- to review scientific evidence and programmatic experience in relation to providing PEP in occupational and non-occupational settings; and
- to recommend a consensus approach to formulating policy and operational guidelines for HIV PEP.
Although the needs of workers and people who have been sexually assaulted provided the focus of the consultation, consideration was given to other types of non-occupational exposure for which PEP might be indicated: specifically, those arising from isolated or episodic injecting drug use and consensual sexual exposure. The consultation recommendations, which are based on current understanding of the efficacy of PEP and available data for comparing different PEP strategies, represent the collective opinion of experts working in this field and form the basis of the present policy guidelines and service delivery recommendations.