Recommended laboratory evaluation for nonoccupational post-exposure prophylaxis (nPEP) of HIV infection*

ALT: alanine aminotransferase; AST: aspartate aminotransferase; HBV: hepatitis B virus; HCV: hepatitis C virus; E: exposed patient; S: source; HBsAg: hepatitis B surface antigen.
* This table is designed to monitor asymptomatic patients receiving tenofovir disoproxil fumarate-emtricitabine as the nucleoside combination with a third agent (eg, an integrase inhibitor or a boosted protease inhibitor). Additional testing (eg, for pregnancy, sexually transmitted diseases, hepatitis) should be performed if clinically indicated.
¶ A lab-based fourth-generation HIV antigen-antibody assay is the preferred test.
Δ HIV serologic testing is indicated for sources of unknown serostatus.
◊ Only if patient became acutely infected with HCV.
§ If zidovudine-lamivudine is used as the nucleoside combination, a complete blood count should be performed while the patient is receiving nonoccupational post-exposure prophylaxis (after approximately two weeks). 
¥ For patients with a sexual exposure. Refer to the topic review in UpToDate that discusses screening of sexually transmitted infections.
‡ Syphilis testing should be performed four to six weeks and six months after a sexual exposure. Chlamydia and gonorrhea testing should be performed four to six weeks after a sexual exposure for those who were not treated empirically at baseline and for those who are symptomatic.  
† For patients who were not immune at baseline and were exposed to a source who is HBsAg-positive or whose HBsAg status is unknown. Refer to the UpToDate topic that discusses nonoccupational exposures to HBV for a discussion of HBV post-exposure prophylaxis.
** If the source tests positive for HCV, additional monitoring of the exposed patient may be required. Refer to the UpToDate topic review that discusses the diagnosis of acute HCV in adults.
¶¶ For the exposed patient, virologic testing should only be performed if symptoms of acute HIV infection develop or if the patient is found to be HIV-infected on serologic testing.