In which scenarios should I refer a patient for specialist assessment

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Refer a patient for specialist assessment after initiating post-exposure prophylaxis (PEP) in the following clinical scenarios:

If the patient tests positive for HIV during follow-up testing, they should be seen by an HIV specialist preferably within 48 hours and certainly within 2 weeks of receiving the result to confirm diagnosis and initiate appropriate management .
If the patient has symptoms suggestive of primary HIV infection or other illnesses that often coexist with HIV, specialist assessment is warranted to guide further testing and management .
If the patient requires ongoing support for adherence, side effects, or monitoring of adverse events, referral to specialist sexual health or HIV services is recommended to provide tailored education, behavioural support, and monitoring, including kidney function monitoring if on PrEP .
If the patient has complex comorbidities or immunosuppression (e.g., HIV, chronic renal disease, cancer, diabetes) that may affect treatment or risk assessment, specialist input is advised .
If the patient is lost to follow-up or has missed appointments for treatment monitoring, specialist teams should be involved to ensure continuity of care .

In which scenarios should I refer a patient for specialist assessment after initiating PEP?