Recommended laboratory evaluation after possible nonoccupational exposure to HIV, HBV, and HCV

Test	Baseline	4 to 6 weeks after exposure	3 months after exposure	6 months after exposure
HIV serologic testing (lab-based fourth-generation HIV antigen-antibody assay preferred test)	E, S (if HIV status unknown)	E	E	E (only if patient became acutely infected with HCV)
Complete blood count with differential^*	E
Serum liver enzymes (ALT, AST)	E	E	E^¶
Blood urea nitrogen/creatinine	E	E
Sexually transmitted diseases screen if exposure through sexual contact^Δ	E, S^◊	E^Δ		E^Δ
Hepatitis B serology (HBsAg, anti-HBs, anti-HBc)	E, S			E^§
Hepatitis C testing	E, S^¶	E^¶	E^¶	E^¶
Pregnancy test (for women of reproductive age)	E	E (if sexual exposure)
HIV viral load^¥	S (only if HIV-infected or if concern for acute HIV)
HIV resistance testing^¥	S (only if HIV-infected)

This table provides guidance on monitoring asymptomatic patients receiving HIV nPEP with tenofovir disoproxil fumarate-emtricitabine or tenofovir alafenamide 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 [STIs], hepatitis) should be performed if clinically indicated based on the type of exposure. Refer to UpToDate content for more detailed information on nPEP regimen selection and HBV postexposure prophylaxis as well as testing for HIV, HCV, and STIs.

ALT: alanine aminotransferase; AST: aspartate aminotransferase; E: exposed patient; HBsAg: hepatitis B surface antigen; HBV: hepatitis B virus; HCV: hepatitis C virus; S: source.

* 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).

¶ The source should be tested for HCV RNA if possible. If the source is HCV-positive or is not available for testing and the exposed patient is HCV negative, additional monitoring of the exposed patient should be performed. This includes testing for HCV RNA and serum aminotransferases at four weeks; testing for HCV RNA, anti-HCV antibody, and serum aminotransferases at three to four months; and testing for HCV RNA and anti-HCV antibody at six months.

Δ Routine screening for STIs after a sexual exposure typically includes testing for gonorrhea, chlamydia, and syphilis. Testing should be performed at baseline. Repeat 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.

◊ Victims of sexual assault should be empirically treated for STIs (eg, gonorrhea, chlamydia) without need for baseline testing. Refer to UpToDate content on management of sexual assault victims for more detailed information on management.

§ For patients who were not immune at baseline and were exposed to a source who is HBsAg-positive or whose HBsAg status is unknown.

¥ For the exposed patient, testing for HIV RNA should only be performed if symptoms of acute HIV infection develop or if the exposed patient is found to have HIV on serologic testing.

Adapted from: Dominguez KL, Smith DK, Thomas V, et al. Updated guidelines for antiretroviral postexposure prophylaxis after sexual, injection drug use, or other nonoccupational exposure to HIV—United States, 2016. United States Centers for Disease Control and Prevention. https://stacks.cdc.gov/view/cdc/38856 (Accessed on April 20, 2016).

Additional information from: Testing and Clinical Management of Health Care Personnel Potentially Exposed to Hepatitis C Virus – CDC Guidance, United States, 2020. MMWR Recommend Rep 2020;69(No. RR-6):1–8.

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Recommended laboratory evaluation after possible nonoccupational exposure to HIV, HBV, and HCV