1. HIV nPEP* Process Algorithm - DRAFT
Apple Pharmacy Closed: Dispense 3 day supply and give 28 day prescription; recommend going to their pharmacy (or Apple) as soon as possible
Perform H&P collect baseline labs
Apple Pharmacy Open: Send to pharmacy and give prescription for 28 days – confirm receipt of meds before D/C
Note Insurance Coverage
Confirm patient contact information :
Has Insurance
Determine need for nPEP medications
Refer to Clinical Algorithm on reverse
Give patient the nPEP brochure
-for any questions, call the immunologist on call
No Insurance
nPEP Prescribed – fax referral form to Immunology at x4385
Dispense 3 day supply, give 28 day supply prescription, and on faxed referral form to Immunology, clearly note that this patient does not have insurance – tell patient that someone from Immunology will contact them on how to fill it
No nPEP and no follow-up needed then nothing further
No nPEP but needs Immunology follow-up, fax referral form to Immunology at x4385
*non-occupational post-exposure prophylaxis

2. Exposure < 72 hours, then assess as Lower Risk vs. Higher Risk
nPEP* Clinical Decision Making Algorithm for Significant Potential HIV Exposure - DRAFT
Send Baseline Labs Rapid HIV
CBC with differential, Hep B surface antigen, Hep B surface antibody, RPR, Hep C antibody, metabolic panel
Exposure < 72 hours, then assess as Lower Risk vs. Higher Risk
Lower Risk– 2 meds
Truvada (emtricitabine and tenofovir) once daily for > 35 kg OR
Retrovir (zidovudine) 20 mg/kg/day divided BID (max 300 mg/dose) AND
Epivir (lamivudine) 8 mg/kg/day (max 150 mg/dose)
Exposure > 72 hours then NO nPEP meds- must follow up in Immunology and/or Child Protection (especially for high risk exposures) for further testing
LOW
HIGH
Higher Risk – 2 meds above PLUS
Reyataz (atazanavir) BID: 150 mg/dose (15-25 kg), 200 mg (25-32 kg), 250 mg (32 to 35 kg )
AND Norvir 100 mg
OR Kaletra (lopinavir/ritonavir) 20 mg/kg/day divided BID (max 400 mg/dose)
High Risk Exposures:
Known HIV positive contact, visible trauma and/or secretions, anal penetration, and other factors (call Immunology if assistance is needed)
Prevention efficacy is increased by use of 3 drugs, but it also decreases compliance
*non-occupational post-exposure prophylaxis