Patients who have completed a course of post-exposure prophylaxis (PEP) should receive structured follow-up care that includes clinical monitoring and appropriate testing to ensure the effectiveness of prophylaxis and to detect any seroconversion or adverse effects early. Follow-up testing for HIV, hepatitis B, and hepatitis C should be conducted according to established timelines, typically at baseline, 6 weeks, 3 months, and sometimes 6 months post-exposure, depending on the pathogen and exposure risk. This testing schedule helps confirm that infection has not occurred despite exposure and that PEP has been effective NICE U.S. Public Health Service 2001Kuhar et al. 2013.
HIV testing should use fourth-generation serological assays or point-of-care tests to detect early infection, with repeat testing recommended at intervals to cover the window period of seroconversion NICE. Patients should be offered pre- and post-test counselling to support informed decision-making and address anxiety or stigma related to testing NICE.
For hepatitis B and C, follow-up testing should include serological and virological assays to detect acute or chronic infection, with attention to vaccination status and immunity for hepatitis B, as well as referral for treatment if infection is detected NICE.
In addition to laboratory testing, patients should be monitored clinically for any adverse effects of PEP medications, adherence to the regimen, and any symptoms suggestive of seroconversion illness or drug toxicity. Support for adherence and education about signs of infection or side effects are essential components of follow-up care U.S. Public Health Service 2001Kuhar et al. 2013.
Routine follow-up clinic visits after completion of PEP are not always required unless clinically indicated, but patients should be advised to promptly report any symptoms suggestive of infection or adverse reactions and have clear pathways to access care if needed NICE,NICE NG33.
Key References
- PH43 - Hepatitis B and C testing: people at risk of infection
- NG33 - Tuberculosis
- NG221 - Reducing sexually transmitted infections
- NG60 - HIV testing: increasing uptake among people who may have undiagnosed HIV
- (U.S. Public Health Service, 2001): Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis.
- (Kuhar et al., 2013): Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis.