Cresswell Fiona, Asanati Kaveh, Bhagani Sanjay, Boffito Marta, Delpech Valerie, Ellis Jayne, Fox Julie, Furness Linda, Kingston Margaret, Mansouri Massoud, Samarawickrama Amanda, Smithson Kat, Sparrowhawk Alex, Rafferty Paul, Roper Tom, Waters Laura, Rodger Alison, Gupta Nadi
Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.
Clinical Research Department, London School of Hygiene and Tropical Medicine, UK.
HIV Med. 2022 May;23(5):494-545. doi: 10.1111/hiv.13208. Epub 2022 Feb 14.
We present the updated British Association for Sexual Health and HIV (BASHH) guidelines for post-exposure prophylaxis (PEP) to HIV following sexual exposures, occupational exposures and other nonoccupational exposures in the community. This serves as an update to the 2015 BASHH guideline on PEP following sexual exposures and the 2008 Expert Advisory Group on AIDS guidelines on HIV PEP. We aim to provide evidence-based guidance on best clinical practice in the provision, monitoring and support of PEP for the prevention of HIV acquisition following sexual, occupational and other nonoccupational exposures in the community. The guideline covers when to prescribe PEP, what antiretroviral agents to use and how to manage PEP. This includes (i) evidence of PEP efficacy; (ii) evidence relating to individual-level efficacy of antiretroviral therapy to prevent the sexual transmission of HIV; (iii) data on the detectable (transmissible) prevalence of HIV in specific populations; (iv) risk of HIV transmission following different types of sexual and occupational exposure; (v) baseline risk assessment; (vi) drug regimens and dosing schedules; (vii) monitoring PEP; (viii) baseline and follow-up blood-borne virus testing; (ix) the role of PEP within broader HIV prevention strategies, for example, HIV pre-exposure prophylaxis (PrEP). The guideline also covers special scenarios such as PEP in pregnancy, breastfeeding and chronic hepatitis B virus infection, and when PEP should be considered in people using HIV PrEP. The guidelines are aimed at clinical professionals directly involved in PEP provision and other stakeholders in the field. A proforma to assist PEP consultations is included. A public consultation process was undertaken prior to finalizing the recommendations.
我们发布了英国性健康与艾滋病协会(BASHH)关于性接触、职业暴露及社区其他非职业暴露后预防艾滋病病毒(HIV)暴露后预防(PEP)的最新指南。这是对2015年BASHH关于性接触后PEP的指南以及2008年艾滋病专家咨询小组关于HIV PEP的指南的更新。我们旨在为在社区中提供、监测和支持预防性接触、职业暴露及其他非职业暴露后预防HIV感染的PEP的最佳临床实践提供循证指导。该指南涵盖何时开具PEP、使用何种抗逆转录病毒药物以及如何管理PEP。这包括:(i)PEP疗效的证据;(ii)抗逆转录病毒疗法预防HIV性传播的个体水平疗效的证据;(iii)特定人群中HIV可检测(可传播)流行率的数据;(iv)不同类型性接触和职业暴露后HIV传播的风险;(v)基线风险评估;(vi)药物方案和给药时间表;(vii)监测PEP;(viii)基线和随访血源病毒检测;(ix)PEP在更广泛的HIV预防策略(如HIV暴露前预防(PrEP))中的作用。该指南还涵盖特殊情况,如孕期、哺乳期和慢性乙型肝炎病毒感染时的PEP,以及使用HIV PrEP的人群何时应考虑PEP。这些指南针对直接参与提供PEP的临床专业人员及该领域的其他利益相关者。其中包括一份协助进行PEP咨询的表格。在确定建议之前进行了公众咨询过程。
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