Regional Medical Services

Post Exposure Preventive (PEP) Treatment : Guidelines for the attending physician

Annex-I

Guidelines for the attending physician

      Offer the patient the possibility of being accompanied during the medical examination by a staff member, friend or counselor.

      Reassure the patient that the record of the accident or injury and follow-up treatment will be treated in a private and confidential manner

      Record precise time of the incident and of the circumstances.

      In the case of sexual assault, explain that there is a risk of having been exposed to STDs (including HIV infection) and the possibility of pregnancy. Where the HIV status of the perpetrator is not known, decisions are to be made as if the perpetrator were HIV-positive.

      In the case of occupational accident, explain to the patient the potential risk in relation to the type of exposure encountered.

      Explain the possibility of reducing the risk of transmission of HIV infection by undergoing a course of post-exposure prophylaxis (PEP). Although the efficacy of taking a triple therapy with a combined tablet of Zidovudine and Lamivudine (Combivir) and Indinavir to prevent HIV infection following sexual assault or occupational accident is not proven, research studies suggest this regime, taken ideally within 2-24 hours and no later than 48-72 hours following possible HIV exposure, may be beneficial in preventing HIV infection.

      Give the patient the leaflet containing the Guidelines for the Patient describing the modalities of PEP and its implications. Highlight the urgent need for the patient to make a rapid decision on this issue (the PEP regimen must start ideally within 2-24 hours and no later than 48-72 hours after exposure). Explain too the potential necessity for medical evacuation for a period of four (4) weeks in order to complete the medical/psychological evaluation and treatment in situations where adequate facilities are not available at the duty station.

      If the patient agrees to start treatment (and has signed the consent form), the following is immediately given from the “PEP starter kit”.

for a female patient only – Pregnancy test to exclude an already existing pregnancy which would be a contraindication to giving the “morning-after” pill and PEP treatment;

for a female patient only – The first tablet of the “morning-after” pill to be taken orally immediately, and one (1) additional tablet to be taken twelve (12) hours after the first; and

for female or male patient – The first doses of the PEP regimen: Zidovudine (300mg) and Lamivudine (150mg) combined tablet: one tablet two times per day; plus Indinavir 400mg: two tablets every eight hours (three times per day).

      Explain to the patient that the combination of the “morning-after” pill taken with these medications will cause severe nausea. The other possible side-effects of Zidovudine, Lamivudine and Indinavir are described in the following table.

      Write a medical report for the attention of the physician at the site of medical evacuation, indicating the circumstances, initial medical findings and treatments started. Send a copy of this report to the Medical Director of the United Nations agency employing the patient.

DRUG REGIMEN (ARV)