Non-occupational Post-Exposure Prophylaxis (nPEP)
What is non-occupational HIV Post-Exposure Prophylaxis (nPEP)?
Non-occupational Post-Exposure Prophylaxis (nPEP) is treatment for a possible exposure to HIV outside of a health care setting. nPEP involves the use of antiretroviral drugs as soon as possible after a high-risk exposure to HIV, to reduce (but not eliminate) the possibility of HIV infection. nPEP is not the "morning after pill" for HIV. nPEP is a four-week program of two or three antiretroviral medications, several times a day. The medications have serious side effects that can make it difficult to finish the program.
Treatment should be started promptly, preferably within the first several hours after an exposure. It should be administered within 48 hours of a high-risk exposure (not to exceed 72 hours). After 72 hours nPEP is considerably less effective in preventing HIV infection. The sooner nPEP is administered, the more effective it is.
What is a high-risk exposure?
nPEP is only recommended for high risk exposures to HIV that have occurred within the past 48 hours. A high risk exposure would include:
- Unprotected vaginal or anal sex with known (or likely) HIV positive partner
- Injection drug use needle exposure
- After a sexual assault
- Non-intact skin (open cut or wound) or mucus membrane (eyes, nose, mouth, etc.) contact with blood
If a high-risk exposure has occurred, what should I do?
In the case of a high-risk exposure to HIV, the individual should be referred immediately to a hospital emergency room (ER). ER staff will determine the severity of the exposure and if the administration of nPEP is necessary. Most hospital ERs should be able to administer nPEP onsite. The hospitals and health centers listed in the "HIV Service and Resource Guide" are funded by the Massachusetts Department of Public Health for HIV primary care services and can also administer nPEP onsite to uninsured and underinsured individuals.
Medical professionals who are unsure if nPEP should be administered should call the National Clinicians' Post-Exposure Prophylaxis Hotline (PEPline) at 1-888-448-4911 for consultation. Hotline staff will help determine if nPEP should be administered, and recommend a treatment regimen specific to the exposure and the source history (if available).
For a list of MDPH sponsored sites that can administer nPEP to individuals who are uninsured or underinsured, please download the "HIV Services and Resource Guide." People with adequate insurance can access nPEP through their health care providers or through most emergency rooms.
Additional Considerations for Sexual Assault Victims
In addition to offering an immediate referral for HIV non-occupational post-exposure prophylaxis (PEP) to sexual assault victims, Sexual Assault Nurse Examiners (SANEs) should be referred to whenever possible.
SANEs are specially trained and certified professionals skilled in performing quality forensic medical-legal exams. The SANEs are available by beeper and respond immediately to the designated SANE site ready to care for the victim of a sexual assault age 12 and over.
SANE protocols as well as a complete listing of Regional SANE Coordinators, designated SANE hospitals and rape crisis centers may be found at: www.mass.gov/dph/fch/sane or by calling 617-586-1365.
National Clinicians' Post-Exposure Prophylaxis Hotline (PEPline): 1-888-448-4911 (for clinical consultation)