Harbor:Non-Occupational Exposure

General Guidelines

Harbor ED Policy [1]

  • Pre-exposure prophylaxis to sexual exposure has been studied as part of a preventive public health strategy and is effective in some well-controlled, very limited circumstances. This is rarely an emergency medicine issue.
  • The possible exception would be the case of exceptionally high risk exposure (partner or assailant in the case of sexual assault is known or highly likely to be HIV positive with a high viral load and the sexual activity was associated with a high risk of transmission, e.g., receptive anal intercourse, sexual assault with vaginal trauma), occurring within the prior 72 hours. Sexual assault victims should be referred immediately to a RAPE center where PEP may be offered as part of the overall care plan.
  • For the vast majority of cases in which a patient seeks post-sexual-exposure HIV prophylaxis, the patient should simply be referred to the Los Angeles LGBT Center. The LA LGBT Gay and Lesbian Center has a program for post-exposure prophylaxis in a number of specific circumstances; patients can be referred within 72 hours of an exposure. Their hours are Mon-Friday 11am-6pm (telephone number is 323-860-5855, and their website is https://lalgbtcenter.org/post-exposure-prophylaxis). The emergency department is generally not the place to start post-sexual-exposure prophylaxis because it ideally is part of an ongoing risk reduction strategy.
  • If you happen to see a patient who meets the criteria in (2) above, then a baseline rapid HIV should be sent to make sure the patient is not already infected. If the baseline rapid HIV test is negative and if the end of the 72 hour window is near, or it is a Friday night or a weekend, then the HIV service may be consulted, as they may choose to offer a few doses of post-exposure prophylaxis for the patient to take prior to being seen at the LA LGBT Center. Please remember that the HIV fellows and attendings are on call for weeks at a time, so middle of the night calls should be reserved for emergencies.

See Also

References

  1. Email from Dr. Lewis on 1/23/18