PrEP

PrEP – Pre-Exposure Prophylaxis PEP - Post-Exposure Prophylacis

Acceptability at Recruitment

Acceptable

Acceptability at CT / Work-Up

Donors should be asked whether they currently take oral PrEP/PEP or have taken it in the past three months, or if they have received injectable PrEP within the last 24 months.

Transplants centres should be informed as soon as possible at the VT stage if the above apply.

Donors should not be asked to stop PrEP/pep to donate. The health and well-being of the donor is our top priority, and PrEP/PEP significantly reduce the risk of HIV transmission.

Guidelines around oral PrEP/PEP have recently changed. Instead of a three-month deferral period, current guidance is to inform the TC of the PrEP and it is their discretion on whether a three month deferral period is required. If the TC feels that the risks of delaying the donation outweigh the risks of a false negative HIV result, then the deferral period can be shortened or waived. A concessionary release form should be completed at the time of clearance if the donation proceeds.

For CT&LS donors whose cells will not be used for human application, donation may proceed if the client is informed and gives their approval. In such cases, a risk assessment should be completed.

It is noteworthy that PrEP/PEP can affect HIV test results. It carries a risk of false-negative NAT results and may also cause false-positive HIV antibody results.

If a positive HIV antibody result is detected in a donor who is taking or has recently taken PrEP/PEP, the work-up should be cancelled, and the donor referred back to their healthcare team. A follow-up blood test would typically be performed three months after discontinuing PrEP/PEP to ensure accurate results. The donor can remain on the register until testing is completed, though if a true positive HIV resultis identified, they should be removed from the register.

Discontinuing PrEP/PEP carries potential risks and can cause anxiety during the waiting period. Donors should be fully informed of these risks when PrEP/PEP use is identified, allowing them to make an informed decision about whether to proceed with the work-up process, which includes HIV testing.

Injectable PrEP may interfere with HIV test results for up to 24 months following the last dose, and so the above considerations apply for 24 months.

Individual at Risk

Recipient, Donor

Explanation of Condition

Pre-Exposure Prophylaxis (PrEP) is used to prevent HIV infection. The main risk associated with PrEP is that it can give false negative HIV NAT results, meaning that early HIV infections may not be picked up. However, false positive HIV antibody results can also occur.

Post-Exposure Prophylaxis (PEP) has a similar mechanism of action to PrEP and may also interfere with testing results. In the UK PEP is prescribed to people who have been exposed to someone who may have HIV. This includes through sexual activity or exposure through a needle stick injury.