University of Tasmania, Australia

Page 1 of 2

• Student name
• Email address

• Regarding the source patient:

  • HIV Positive – Duration (if known)
  • Viral Load/CD4 count (if known)
  • Other Co-morbidities (if known)
  Nature of injury and bodily fluid exposed to
  Time of incident 12345678910111213141516171819202122232425262728293031JanFebMarAprMayJunJulAugSepOctNovDec20112012 000102030405060708091011121314151617181920212223:000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859

• Notify your supervisor immediately.

• HIV status of the patient?

  Your supervisor should organise this.

Locate the HIV PEP flowchart to determine your specific risk and recommended treatment. In brief this is:

• Low risk (e.g. low risk exposure and negative patient) – no prophylaxis or
• Moderate risk – antiretroviral prophylaxis with Truvuda or
• High risk - antiretroviral prophylaxis with Kaletra

This needs to start within 72 hours of exposure.

Contact the Director of Electives in Tasmania who will provide advice and liaise with Tasmanian infectious disease physicians or HIV specialists in Melbourne.

If you start the 7 day kit you must return home within one week or obtain local supplies of oPEP to complete the course.

On arrival, organise urgent advice from the Infectious Disease Clinic at the teaching hospital – including further HIV PEP treatment.