European guidelines

Guidelines for post-exposure prophylaxis (PEP) following non-occupational exposure were published by the European Project on Non-Occupational Post-exposure Prophylaxis in June 2004.ref]

The guidelines recommend PEP following unprotected receptive anal sex and needle or syringe exchange, when the source person is known to be HIV-positive or from a group with high HIV prevalence. They state that it should be considered after vaginal sex or insertive anal sex with someone known to be HIV-positive, as well as following receptive oral sex with ejaculation or a splash of semen into the eye from an HIV-positive source. However, following rape or other high-risk factors, such as bleeding, ulcers around the genitals or in the mouth, or sexually transmitted infections, PEP should be used more readily.

Unlike British guidelines, the European guidelines state that any combination of drugs licensed for HIV-infected patients can be used, with the simplest and least toxic combinations being preferred. Triple-drug combinations are preferred, two drugs may be an option. They also recommend efavirenz (Sustiva) for people who are not pregnant, despite the drug’s possible side-effects. However, if the source is known to be HIV-positive and treatment history can be obtained or a resistance test carried out, the results may be used to determine the best choice of drugs for PEP.

PEP should be started within 72 hours of exposure, starting as early as possible and lasting four weeks, with recipients receiving medical attention and counselling for at least six months.