HIV Post-Exposure Prophylaxis

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🧾 Case Summary: 6-year-old child with a one-week history of progressive periorbital (eye) oedema, more pronounced in the morning, plus pitting oedema of the lower limbs. Urinalysis shows heavy proteinuria (>3.5g/day). Labs reveal hypoalbuminaemia (albumin 20 g/L) and hyperlipidaemia, but normal renal function and normal blood pressure.

💊 PEP Indication: No — There is no indication for HIV Post-Exposure Prophylaxis (PEP) in this scenario. Rationale: This case is consistent with nephrotic syndrome, not a scenario where PEP is relevant (no HIV-risk exposure).

📋 Recommended Regimen: Not applicable. No HIV PEP required.

🧪 Baseline Investigations: Investigations relevant to nephrotic syndrome (not PEP):

• Renal panel (already normal)
• Serum albumin, lipid profile (done)
• Urinalysis, spot urine protein:creatinine ratio or 24h protein (heavy proteinuria confirms diagnosis)
• Consider serologies (HBV, HCV, HIV, ANA) for secondary causes
• Possible renal biopsy if atypical features

📅 Follow-up:

• Monitor urine protein, serum albumin, lipids, and renal function
• Monitor blood pressure
• Assess for complications (infection, thrombosis)
• Pediatric nephrologist referral

⚠️ Additional Notes:

• First-line management for idiopathic minimal change nephrotic syndrome is oral corticosteroids.
• No evidence of infection or secondary cause at present.
• No PEP required unless a qualifying HIV exposure occurs.
• Ensure immunisation status is up to date (risk of infection increases in nephrotic syndrome).

Reference: This recommendation is based on the clinical features and laboratory findings presented. For HIV PEP guidance, see:

• Australian National Guidelines for Post-Exposure Prophylaxis after Non-Occupational Exposure to HIV — ASHM, 2021. ASHM Non-Occupational PEP Guidelines (PEP is indicated only following specific high-risk HIV exposures.)

If there is a potential HIV exposure scenario (e.g., needlestick injury, sexual exposure), please provide further details for tailored PEP advice.