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Nonoccupational post-exposure prophylaxis (nPEP) is antiretroviral
treatment started after a possible HIV exposure outside a workplace setting.
The CDC's guidance sets out which exposures warrant it.
The instruction that governs all the others
**Persons with a recent HIV exposure might be concerned about disclosing all
details of the behaviors that might have exposed them to HIV.** Multiple
factors might contribute, including **trauma from sexual assault, concerns
about stigma, and medical mistrust**.
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**Health care professionals can prescribe nPEP to persons who request it,
even if they are unable to elicit all details necessary to assess HIV
acquisition risk.**
That paragraph sits at the top of the exposure table, and it is the most
important thing on the page. Every row below it assumes a full account of what
happened. This one says: where you cannot get that account, prescribe anyway.
nPEP is time-critical. A clinician who withholds it pending a complete history
from someone who has just been assaulted has, in practice, withheld it.
For clinical consultation there is the NCCC PEPline: 888-448-4911.
When nPEP is not recommended
| Exposure | Why |
|---|---|
| Sexual exposure with an intact condom | Used as recommended, condoms are highly effective at preventing HIV transmission. If the condom was not used consistently or correctly throughout, treat the situation as an exposure without one |
| The exposed person is taking PrEP as recommended | PrEP taken as directed is highly effective, so nPEP is not generally recommended |
| The source has sustained viral suppression | Defined here as HIV treatment for more than 6 months, consistent high adherence, and a suppressed viral load |
Four exceptions on PrEP
Even for someone on PrEP, nPEP may be considered if they:
- Recently started PrEP and may not have reached maximum protection
- Have missed doses
- Are using an intermittent regimen outside current CDC guidance
- Were exposed to a source **without sustained viral suppression and with
resistance to PrEP components**
The pattern across the whole table: the "not recommended" answers all depend
on something having been done correctly and consistently, and every row
includes the exception for when it was not.
Source: Centers for Disease Control and Prevention.
Licens: CC0 1.0 (allmän egendom) · Bearbetat efter www.cdc.gov
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