Post-Exposure Prophylaxis (PEP) Guideline Updates

Aug 22nd, 1970

By Elizabeth Wynkoop Program Coordinator (SAFE/SART)

When someone is sexually assaulted, they may face a number of medical concerns, including, in some cases, the possible risk of HIV infection. While this can be a frightening possibility, postexposure prophylaxis, commonly referred to as PEP, is an option for reducing the risk of infection for victims who may have been exposed to HIV.  PEP is a 28-day long course of a combination of anti-retroviral medications that can significantly decrease the risk of HIV infection following exposure by preventing HIV from replicating and spreading in the body. 

This spring, the Center for Disease Control and Prevention (CDC) released the Updated Guidelines for Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV. These guidelines are written for medical practitioners to keep them up-to-date on the latest research and to provide recommendations on best practices in non-occupational PEP (nPEP) administration.  Guidelines for occupational PEP, designed for individuals who may have been exposed to HIV in the workplace, were separately published in 2013 and are available online from the CDC. The guidelines for nPEP were last updated in 2005 by the U.S. Department of Health and Human Services, and since then, there has been new information about the proper clinical delivery of nPEP, newer antiretroviral drug regimens that have reduced side effects, and research regarding the cost-effectiveness of nPEP.

The updated 2016 CDC guidelines review the recent research on nPEP, and, based on these new developments, recommend revised regimens for nPEP, guidelines for the rapid antigen/antibody (Ag/Ab) combination HIV test, which provides fast results on a patient’s HIV status, laboratory evaluation schedules, and treatment guidelines for other sexually transmitted infections and hepatitis. The guidelines also address some of the additional challenges related to providing nPEP to patients, including maintaining confidentiality and helping patients handle the high costs associated with the medications.  The CDC provides links to medication assistance programs run by pharmaceutical companies and to the Crime Victim’s Compensation Program in each state, both of which may be able to assist with costs. The guidelines include information specifically on the use of PEP with victims of sexual assault, and provide special considerations for ensuring that these patients are able to successfully access and complete a full course of PEP when needed.

While these guidelines are written for medical professionals, it is important for all sexual assault service providers to be aware of the availability of PEP. These medications can be an invaluable resource for survivors of sexual assault who fear they may have been exposed to HIV infection, but in cases of potential exposure, immediate medical attention is essential, as PEP is only effective if started within 72 hours after exposure, and is most effective in the first two hours after exposure. For more information, please visit the CDC’s webpage HIV Basics-PEP

In the coming months, the CDC will be hosting several webinars explaining the new guidelines and providing technical assistance to health care providers as well as other community-based organizations, and will be producing new informational online materials and patient education materials. Look for these materials as they are produced on the CDC’s webpage for Preventing New HIV Infections.  

Survivors can find out more information about receiving expert, trauma-informed care from their local Sexual Assault Forensic Examiner (SAFE) program by calling their local Rape Crisis Center (RCC) or the SAFE Hospital in their area.

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