Belgian guidelines for non-occupational HIV post-exposure prophylaxis 2017

Abstract

We present the updated Belgian guidelines for the use of non-occupational HIV post-exposure prophylaxis (NONOPEP). This document is inspired by UK guidelines 2015, adapted to the Belgian situation and approved by all AIDS reference centers in Belgium. When recommended, NONOPEP should be initiated as soon as possible, preferably within 24 h of exposure but can be offered up to 72 h. The duration of NONOPEP should be 28 days. These current guidelines include epidemiologic estimations, which can be used to calculate the risk of infection after a potential exposure and help to decide whether or not to start prophylaxis. We review which medications to use in the context of the last Belgian NONOPEP convention, provide a checklist for initial assessment, and make recommendations for monitoring individuals receiving NONOPEP.

Drug users’ perceptions, demands, and suggestions for non-occupational post-exposure prophylaxis (nPEP) services in China: a qualitative study

“…At present, nPEP service has been gradually routinized in many regions of the world. The guidelines of PEP in many countries (e.g., USA, UK and Belgian) have been issued for years and updated recently [9][10][11].…”

Exploring the issues of HIV post-exposure prophylaxis and sexually assaulted individuals

“…Some had a formal development approach, which included working with group members from different healthcare disciplines, detailed information on how evidence was selected for the guideline's recommendations, how the evidence was graded, and the process for disagreements. Other guidelines had a simpler approach: the Belgian guidelines were inspired by the UK in that they agree with the UK's medication regimen, but needed to include ART, which is covered within the Belgian national healthcare system (Libois et al, 2018). The Myanmar guidelines on PEP was extremely limited and directed healthcare professionals to the supplemental section at the end which included the WHO PEP guidelines (Department of Public Health Ministry of Health and Sports, Myanmar, 2017).…”

“…The search strategies the various working groups used for determining evidence for the HIV PEP guidelines varied across the guidelines. Many guidelines reported the use of different databases to find relevant evidence-based literature including; Medline, Embase, PubMed, Cochrane database, CHINAL, the Web of Knowledge, and Google Scholar (Centers for Disease Control and Prevention, 2016;Cresswell et al, 2016;Ford et al, 2015;Health Protection Surveillance Centre, 2016;Libois et al, 2018;Tan et al, 2017). Other literature searches found evidence for the guidelines within core journals relevant to blood-borne viruses, reviews of conference publications, and current hospital policies and standard operating procedures Health Protection Surveillance Centre, 2016).…”

“…In a non-healthcare work related setting, HIV exposure is known as non-occupational post-exposure and prophylactic treatment is called non-occupational post-exposure prophylaxis Factors known to increase the risk of HIV transmission that are also associated with sexual assault include: injuries sustained during the assault in a mucosal or genital region (Cresswell et al, 2016;Kennedy, 2013;Libois et al, 2018); the first time of vaginal penetration (Libois et al, 2018); being assaulted by multiple assailants; having multiple sexual assault acts committed (Wieczorek, 2010); and having a previous sexually transmitted infection at the time of the assault (Cresswell et al, 2016). In addition, certain assailant factors can increase the risk of contracting HIV, especially if the assailant is already HIV positive , has a high HIVpositive viral load , if ejaculation occurred during the assault or if there was no condom use male was non-circumcised (Tobian, Kacker, & Quinn, 2014), if there is a high probability of HIV in the assailant (i.e., IV drug user, or male who has sex with males) (Tan et al, 2017), or when the assailant's country of origin has a high prevalence rate of HIV (Libois et al, 2018). ).…”

“…Some guidelines combined PEP and Pre-Exposure Prophylaxis (PreP) information (Tan et al, 2017;Tumarkin et al, 2018). Other guidelines focused only on non-occupational PEP (Australian Society for HIV Medicine, 2016; Centers for Disease Control and Prevention, 2016;Libois et al, 2018). The United Kingdom (UK) guidelines were specific to sexual exposures only (Cresswell et al, 2016) The Irish PEP guidelines were a subsection of their extensive guidelines on emergency management of injuries and all blood-borne virus (BBV) exposures (Health Protection Surveillance Centre, 2016).…”