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HIV Out-of-Hours pathway

Advice for clinicians dealing with common HIV telephone triage scenarios. Please contact the HIV doctor on-call via switchboard if you are uncertain about giving advice that is not included in the guidelines

healthcare professional wearing stethoscope on mobile phone with pen

Antiretroviral (ARV) treatment  

Patient has run out of treatment 

  • Complete the HIV Out-of-Hours online form and the HIV team will contact between Mon-Fri 9-5
  • If at the start of a bank-holiday weekend (or patient will be without medication for a prolonged period of time) – Contact the HIV Doctor on call via switchboard (avoid during the night and handover to day team)

Patient has missed or was late taking their medication 

  • Advise patient to take the missed/late dose as soon as possible – and continue with the next dose at the usual time as planned
  • Advise not take missed dose if next dose is already due, just take normal dose and continue as normal
  • If patient is unsure whether they have taken a dose or not it is safer to retake than miss a dose

Ward stock of Antiretroviral treatment 

Ward stock of ARVs are available from the treatment room cupboard on CY6 (not in the normal drug cupboards) 

Drug Interactions 

For general advice:

  • Complete the online HIV Out-of-Hours form – the HIV pharmacy team will contact between Mon-Fri 9-5

For more urgent drug interaction advice, or urgent prescribing queries from other healthcare professionals: 

  • Contact the HIV Doctor on call via switchboard

ARV Side effects  

  • Complete the online HIV Out-of-Hours form listing side effects
  • If severe (especially if the patient has started new ARV within past 8 weeks) Contact the HIV Doctor on call via switchboard
  • Advise patients not to stop taking their ARV medication
  • If vomiting back ARVs for more than 2 days complete form – consider contacting doctor on call if at the start of bank-holiday weekend

Patients needing HIV Post exposure prophylaxis (PEP) 

Information:

Refer patients to A&E 

Urgent or immediate health problems 

If the patient has any of the following scenarios, advise they call 999:

Crushing chest pain
Chest pain with radiation
Severe or acute dyspnoea
Sudden loss of limb power with/without bladder/bowel
Loss of sensation in bladder/bowel
Status epilepticus
Unconscious
Severe haematemesis/ GI bleed
overdose or attempted suicide

Refer to Urgent Care Centre or 111 for other urgent presentations, such as: 

New dyspnoea or worsening dyspnoea, Blurred/loss of vision, Blackouts, Seizure, Headache with fever and CNS symptoms, Neck stiffness /Photophobia, Widespread rash with/without mouth involvement with additional , fever, nausea and shortness of breath. New jaundice, Not tolerating food or fluids, Systemic  Pain >7/10 in any site Pyrexia > 38C and at risk of neutropenia, Pyrexia with tachycardia and rigors, Actively bleeding with known bleeding disorder (ITP/anticoagulants, low platelets)