Approach to postexposure prophylaxis against bloodborne viruses

Australasian Society for HIV Viral Hepatitis and Sexual Health Medicine (ASHM) 2023Australian Technical Advisory Group on Immunisation 2018National HBV Testing Policy Expert Reference Committee 2020National Hepatitis C Testing Policy Expert Reference Committee 2023Ong 2023

Bloodborne viruses include hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV) and human T-cell lymphotropic virus type I (HTLV-I). Transmission of a bloodborne virus can result from:

  • percutaneous injury (eg needlestick injury, injury with a sharp object)
  • contact of mucous membranes or nonintact skin (eg chapped or abraded) with blood, tissue, or other potentially infectious body fluids (eg sexual exposure)
  • transmission from birthing parent (eg mother) to child during pregnancy, labour or breastfeeding.

For postexposure prophylaxis (PEP) in adults, advice is included in these guidelines for:

For postexposure prophylaxis in children, see the Australian and New Zealand Paediatric Infectious Diseases Group (ANZPID) Guidelines for non-occupational postexposure prophylaxis (nPEP).

For postexposure prophylaxis against HIV in neonates, see Neonatal antiretroviral prophylaxis. For postexposure prophylaxis against hepatitis B virus in neonates, see the Australasian Society for Infectious Diseases (ASID) guideline Management of Perinatal Infections.

Detailed local protocols (based on state, national or international guidelines) for occupational and nonoccupational exposures may be available from individual health services. For a list of Australian and international guidelines, see Australian and international postexposure prophylaxis against bloodborne viruses guidelines.
Figure 1. Australian and international postexposure prophylaxis against bloodborne viruses guidelines.

Australasian Society for Infectious Diseases (ASID) 2023Australian Society for Infectious Diseases (ASID) 2022

Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine. Post-Exposure Prophylaxis after Non-Occupational and Occupational Exposure to HIV: Australian National Guidelines (Third edition). ASHM; 2023. [URL]

Australasian Society for Infectious Diseases (ASID). Management of Perinatal Infections. 3rd ed. Sydney: Australasian Society for Infectious Diseases; 2022. [URL]

Australian and New Zealand Infectious Diseases Group (ANZPID). Guidelines for non-occupational post-exposure prophylaxis (nPEP) following exposure to body fluids. Sydney: Australian and New Zealand Infectious Diseases Group; 2023. [URL]

Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Updated guidelines for antiretroviral postexposure prophylaxis after sexual, injection drug use, or other nonoccupational exposure to HIV. Centers for Disease Control and Prevention (CDC); 2016. [URL]

Cresswell F, Asanati K, Bhagani S, Boffito M, Delpech V, Ellis J, et al. UK guideline for the use of HIV post-exposure prophylaxis 2021. HIV Med 2022;23(5):494-545. [URL]

Schillie S, Murphy TV, Sawyer M, Ly K, Hughes E, Jiles R, et al. CDC guidance for evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management. MMWR Recomm Rep 2013;62(RR-10):1-19. [URL]

Updated US Public Health Service Guidelines for the management of occupational exposures to HIV and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol 2013;34(9):875-92. [URL]

Testing for HCV infection: an update of guidance for clinicians and laboratorians. MMWR Morb Mortal Wkly Rep 2013;62(18):362-5. [URL]