In some instances, post-exposure prophylaxis (PEP) will be appropriate to prevent HIV transmission within 72 hours of exposure to HIV. The National Guidelines for Post-Exposure Prophylaxis after Non-Occupational Exposure to HIV1 (2007) states:
There are a variety of scenarios when non-occupational post-exposure prophylaxis (NPEP) may be indicated. Ultimately, the clinician will be evaluating factors that cannot be addressed in [the] guidelines and will make a clinical judgment considering all [the] variables. The guidelines are not, therefore, prescriptive, but put forward cases where NPEP is recommended; where NPEP should be considered (where the risks of treatment may assume a greater weight and the evidence of benefit is less) and cases where NPEP is not recommended (where the treatment risks outweigh the risk of exposure). The assessment of risk exposure is based on the limited prospective data (where available)2. Adverse effects caused by antiretrovirals, used for both NPEP and treatment of HIV, and their impact on adherence are frequent and well recognised. Anticipated ability to complete the full 28-day course is a very important factor to consider before recommending NPEP.
The guidelines proceed to outline risk and treatment options. In short, NPEP should be considered if the potential benefits of treatment are greater than the risks of treatment.
There are no Australian cases establishing a legal duty to offer NPEP. However, a person who is not offered NPEP and acquires HIV could argue that the clinician has been negligent. The clinician’s failure to follow the national guidelines could be taken into account by a court as evidence that the clinician has breached his or her duty of care in a particular case.
New National PEP Guidelines are expected to be available in 2013.
1Australian Government Department of Health and Ageing. National Guidelines for Post-Exposure Prophylaxis after Non-Occupational Exposure to HIV. Canberra: Commonwealth of Australia; 2007. Available at: http://www.health.sa.gov.au/PEHS/publications/2007-national-NPEP-guidelines.pdf (last accessed November 2012).
2 As there is currently no high level evidence of NPEP benefit (randomised control studies or cohorts).