The Centers for Disease Control and Prevention (CDC) have listed a number of situations when it is appropriate to consult an expert about postexposure prophylaxis (PEP) for human immunodeficiency virus (HIV).
When to consult a specialist about HIV PEP:
(1) delayed report of the exposure or initiation of PEP (> 72 hours after the exposure)
(2) unknown source
(3) exposed person may be pregnant (known or suspected)
(4) exposed person is breastfeeding
(5) possible exposure to a viral strain resistant to antiretroviral agents
(6) toxicity of the PEP regimen
(7) serious comorbid conditions and/or polypharmacy in the exposed person (especially those affecting pharmacodynamics)
Additional comments:
(1) A delay in starting PEP does not mean that the patient will not benefit from it.
(2) Do not delay starting PEP while waiting to consult with the expert or for results of additional testing.
(3) Do not test needles or other “sharps” for HIV virus.
(4) Common adverse effects of PEP may respond to antiemetic and/or antimotility agents without changing the regimen.
(5) If you suspect resistance to one of the drugs then select an alternative agent.
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