Test Guideline 2

January

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Benefits, Limitations, and Risks of CAB/RPV LA as ART > Adverse effects

Benefits, Limitations, and Risks of CAB/RPV LA as ART > Adverse effects

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Recommendations Test

RECOMMENDATION
  • EXPOSURE TO HIV IS AN EMERGENCY: When an individual reports a sexual exposure or an exposure to blood, visibly bloody fluids, or other potentially infectious material from an individual known to have HIV or whose HIV status is not known, clinicians should administer the first dose of post-exposure prophylaxis (PEP) immediately—ideally within 2 hours and no later than 72 hours post-exposure. (A2) The following recommended regimens also have activity in the rare possibility of an exposure to known HIV-2 or a source patient at risk for HIV-2 infection:
    • Tenofovir disoproxil fumarate/emtricitabine plus raltegravir (TDF/FTC plus RAL; Truvada plus Isentress) or
    • TDF/FTC plus dolutegravir (TDF/FTC plus DTG; Truvada plus Tivicay) [a]
    • Lamivudine (3TC; Epivir) may be substituted for FTC in either regimen.
    • Raltegravir (RAL; Isentress) may be prescribed in the high-dose formulation, but the high-dose formulation should not be given to pregnant patients.
    • See the NYSDOH AI guideline Diagnosis and Management of HIV-2 in Adults.
  • First dose of PEP for an individual who weighs <40 kg (88 lb): See Table 4: PEP Regimens for Patients 2 to 12 Years Old Who Weigh <40 kg.
  • If the initial emergency dose of PEP is declined, clinicians should inform the exposed individual of the results of the source’s HIV test if and when available. (A3)
  • If the exposed individual’s baseline HIV test result indicates HIV infection before the reported exposure, then clinicians should recommend initiation of antiretroviral therapy (ART) and refer the patient to an experienced HIV care provider. (A1)
  • Clinicians should not provide PEP later than 72 hours after a potential exposure to HIV. (A2)
    • If an individual presents for PEP past 72 hours post exposure, clinicians should perform baseline HIV testing and recommend serial HIV testing at 4 and 12 weeks post exposure. (A2)
  • When an individual who has been taking pre-exposure prophylaxis (PrEP) with daily adherence requests PEP following a sexual exposure, clinicians should advise that additional antiretroviral (ARV) medication for PEP is not warranted in most situations (see below for discussion of scenarios in which PEP may be appropriate). (B1)
  • If the source is not available: When the source of a high-risk exposure is not available for HIV testing, clinicians should recommend that the exposed individual complete the 28-day PEP regimen. (A2)

Note:

  1. The recommendation regarding discussion of the small risk of teratogenicity with DTG in the first trimester and the need for birth control while completing the 28-day PEP regimen has been removed. DTG has been shown to be safe throughout pregnancy. See the MCCC’s statement on Use of Dolutegravir in Individuals of Childbearing Capacity for further discussion Zash, et al. 2022.

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Abbreviation: HCV, hepatitis C virus; NAAT, nucleic acid amplification test.

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In cases of non-sexual exposure in children aged 2 to 12 years, the medical record should be checked for history of tetanus vaccination.

Table 1: Baseline Testing Based on Age of Exposed Individual and Type of Exposure
Test Age of Exposed Individual and Exposure Type
HIV-1/2 antigen/antibody combination immunoassay (HIV RNA testing may be required in some cases and within 72 hours in some cases)
  • ≥2 years: All exposures
Serum liver enzymes, blood urea nitrogen, creatinine
  • ≥2 years: All exposures
Complete blood count
  • 2 to 12 years: All exposures
Pregnancy (individuals of childbearing capacity)
  • 2 to 12 years: Sexual exposure
  • ≥12 years: All exposures
Hepatitis B serology panel (surface antigen, surface antibody)
  • ≥2 years: All exposures
HCV antibody
  • ≥2 years: All exposures
Rapid plasma reagin (RPR)
  • 2 to 12 years: Sexual exposure
  • ≥12 years: All exposures
Gonorrhea/chlamydia NAAT, by site
  • 2 to 12 years: Sexual exposure
  • ≥12 years, consensual sexual exposure
  • May offer for sexual assault exposure
Trichomonas NAAT
  • 2 to 12 years: Sexual exposure
  • >12 years: Consensual sexual exposure
  • May offer for sexual assault exposure

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Last updated on March 25, 2024