What is non-occupational HIV Post-Exposure Prophylaxis (nPEP)?
Non-occupational post-exposure prophylaxis (nPEP) for HIV is the use of antiretroviral drugs as soon as possible after a high-risk exposure to HIV. Antiretroviral drugs combat HIV infections by attacking the virus' DNA. It helps to reduce (but not eliminate) the possibility of HIV infection.
It is important to understand that 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 as soon as possible, 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 much 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?
If you believe you have had a high-risk exposure, you should immediately visit a hospital emergency room (ER). The ER staff will determine how severe the exposure was, and will decide if the administration of nPEP is necessary. Most hospital ERs should be able to administer nPEP onsite.
If you are a medical professional who is unsure if you should administer nPEP, you should call the National Clinicians' Post-Exposure Prophylaxis Hotline (PEPline) at (888) 448-4911 for consultation. They are available between 9 a.m. and 2 a.m. ET. 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).
nPEP Resources
- Any prescribing clinician can provide nPEP
- For evaluation, you can go to:
- Your primary care provider
- A community health center
- An urgent care center
- A hospital emergency room
- nPEP is covered by most insurance, but for those who are uninsured/underinsured, the HIV Drug Assistance Program (HDAP) can be used to pay for nPEP
- See sites enrolled to use HIV Drug Assistance Program (HDAP) for nPEP, available from the Community Research Initiative of New England.
Additional Considerations for Sexual Assault Victims
Along with a referral for nPEP, sexual assault victims should also be referred to a Sexual Assault Nurse Examiners (SANEs) 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.