HIV Needle-Stick Risk Assessment Stratification Protocol (RASP)
Structured risk stratification tool guiding post-exposure prophylaxis (PEP) decisions following occupational or non-occupational HIV exposure. Considers source HIV status, exposure type, and clinical context to determine PEP indication.
Score interpretation
PEP not indicated — exposure >72 hours OR source HIV-negative OR minimal exposure to intact skin
→ No PEP required; document exposure and decision clearly; wound management (wash with soap and water, irrigation of mucous membranes); follow-up HIV test at 6 weeks and 12 weeks; occupational health or sexual health clinic documentation; address root cause of exposure; advise on window period and symptoms of seroconversion
Low-risk exposure — PEP may not be warranted but expert review recommended
→ Consult occupational health or ID specialist urgently (<2 hours); risk-benefit discussion with patient; if source available, expedite HIV testing; if source HIV+ and undetectable VL = U=U (Undetectable = Untransmittable); wound care; baseline HIV serology; consider PEP if patient anxious or if any doubt; support and counselling
Significant HIV exposure risk — initiate PEP as soon as possible (<72 hours)
→ Start PEP ASAP (ideally within 2 hours, must be <72 hours): tenofovir/emtricitabine + raltegravir or dolutegravir (28-day course); baseline HIV test, HBV, HCV, FBC, U&E, LFT; report to occupational health/ID service; follow-up at 4 weeks (toxicity), 8 weeks; HIV test at 6 and 12 weeks post-exposure; Hep B immunoglobulin if unvaccinated source HBsAg-positive; psychological support
Interpretation bands for the HIV Needle-Stick RASP. Apply clinical judgement and local guidance.
References
- BHIVA/BASHH/BIS. UK guideline for the use of HIV post-exposure prophylaxis 2021. HIV Medicine. 2022;23(Suppl 4):s1–s87.
Related
Curated clinical cross-links plus same-class fallbacks.
- Palivizumab · RSV Prophylaxis — Monthly Monoclonal Antibody (High-Risk Infants)
- Enoxaparin (VTE Prophylaxis — Post-Surgery) · Low Molecular Weight Heparin (LMWH) — VTE Prophylaxis
- Rivaroxaban (Perioperative VTE Prophylaxis) · Direct Oral Anticoagulant — VTE Prophylaxis Post-Surgery
- Lisinopril (HFrEF / Post-MI) · ACE Inhibitor / HFrEF
- Colchicine (Pericarditis / Post-MI Inflammation) · Pericarditis / Coronary Inflammation
- Clopidogrel (ACS / Post-PCI) · Antiplatelet / ACS
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.