HIV - Post-Exposure Prophylaxis (PEP)

Developed in collaboration with CASA Medical.

Human immunodeficiency virus (HIV) post-exposure prophylaxis (PEP) following potential or known exposure to HIV in sexual, occupational, and non-occupational settings utilises a first-line two-drug regimen of co-formulated tenofovir disoproxil (TD) and emtricitabine (FTC), with the addition of dolutegravir 50 mg daily OR raltegravir 1200 mg daily for 28 days when three-drug PEP is recommended.

This protocol refers to PEP treatments that include:

Two drug regimen of TD/FTC
Three drug regimen of TD/FTC plus dolutegravir OR raltegravir

This medication is generally well tolerated. Do not stop taking your medication unless directed by your doctor. After initiating PEP HIV laboratory testing is undertaken at 4 –6 weeks and 3 months after exposure.

Pilot and controller information

Pilots or controllers must stop flying or operating and contact their ME if:

They commence PEP and should not fly or operate for a minimum period of 1 week to assess medication suitability and side effects.
They experience significant headache, fatigue, gastrointestinal upset, and muscle pains stop.
There are any safety relevant abnormal testing results.

Aeromedical relevance and implications

The effect of treatment on the aviation task
- Acute Incapacitation due to medication side effects on starting treatment – e.g. vomiting.
- Subtle incapacitation due to medication side effects on starting treatment – e.g. anxiety from potential HIV exposure, muscle pains.
The effect of aviation (task and environment) for treatment: Nil
List of information that must be provided to ME.

Initial testing

Prior to commencement of PEP, patients should have a negative HIV test, hepatitis B and C serology, and kidney function test (eGFR).
Screening for other STIs (as per National STI guidelines) and a pregnancy test for women of child-bearing potential.
Other testing should be on the advice of the treating doctor.
Results must be reported to CAA at the time of PEP treatment only if they are abnormal/positive.

Ongoing surveillance requirements

After initiating PEP, HIV testing at 4 –6 weeks and three months after exposure is needed.

Renewal

At renewal medicals, MEs should review the testing and results that have been conducted for any course of PEP that has been undertaken since the last medical examination. These include:

HIV serology
Hep B and C serology
Results of any other tests the treating doctor has requested
Treatment provider reports

ME aeromedical decision guide

ALL the following criteria must be met before a medical examiner may issue a medical certificate. All documentation regarding the assessment must be sent to CAA.

ME must confirm	Tick
PEP drugs being used for an appropriate clinical indication as outlined in the in the ASHM National PEP Guidelines
Absence of side effects. such as nausea, gastrointestinal upset, diarrhoea and headaches myalgias and arthralgias have been reported.
Recommended laboratory testing is negative
ME considers safe to certify

An AMC referral to CAA NZ AvMed is required if a pilot’s or controller’s condition does not meet all the above criteria and they consent to their condition being considered under flexibility to the CAR 67 rules.

ME letters

HIV-PEP medical certificate letter [DOCX 22 KB]