From the Guidelines
Post-exposure prophylaxis (PEP) for HIV should be initiated as soon as possible, ideally within 72 hours of exposure, with a 28-day course of highly active antiretroviral therapy (HAART) for individuals who have had nonoccupational exposure to blood, genital secretions, or other potentially infectious body fluids of a person known to be HIV infected. This recommendation is based on the guidelines from the U.S. Department of Health and Human Services [ 1 ]. The decision to initiate PEP should be made on a case-by-case basis, taking into account the risks and benefits of treatment. Some key points to consider when evaluating the need for PEP include:
- The type of exposure and the likelihood of HIV transmission
- The time elapsed since exposure
- The HIV status of the source person, if known
- The presence of any other health risks resulting from the exposure
According to the guidelines, PEP is recommended for individuals who have had nonoccupational exposure to HIV within 72 hours [ 1 ]. The regimen typically includes a combination of antiretroviral medications, which should be started as soon as possible after exposure. It is also important to note that PEP is not recommended for individuals who seek care more than 72 hours after exposure, unless the exposure confers a serious risk for transmission [ 1 ]. In such cases, the potential benefits and risks of PEP should be carefully weighed. Additionally, other health risks resulting from the exposure should be considered, and prophylaxis administered when indicated [ 1 ].
The effectiveness of PEP decreases with time after exposure, which is why prompt initiation is crucial [ 1 ]. Reevaluation of the exposed person should be considered within 72 hours postexposure, especially as additional information about the exposure or source person becomes available [ 1 ]. If a source person is determined to be HIV-negative, PEP should be discontinued [ 1 ]. Overall, the goal of PEP is to prevent HIV infection by inhibiting replication or neutralizing the virus before it can spread throughout the body.
From the FDA Drug Label
In all exposures, a regimen combining Hepatitis B Immune Globulin (Human) with hepatitis B vaccine will provide both short- and long-term protection, will be less costly than the two-dose Hepatitis B Immune Globulin (Human) treatment alone, and is the treatment of choice. HyperHEP B is indicated for post-exposure prophylaxis in the following situations: Acute Exposure to Blood Containing HBsAg Perinatal Exposure of Infants Born to HBsAg-positive Mothers Sexual Exposure to an HBsAg-positive Person Household Exposure to Persons with Acute HBV Infection
Post-exposure prophylaxis is indicated in various situations, including:
- Acute exposure to blood containing HBsAg
- Perinatal exposure of infants born to HBsAg-positive mothers
- Sexual exposure to an HBsAg-positive person
- Household exposure to persons with acute HBV infection The recommended regimen combines Hepatitis B Immune Globulin (Human) with hepatitis B vaccine to provide both short- and long-term protection 2.
From the Research
Post Exposure Prophylactic (PEP) Overview
- PEP is effective in preventing illness after potential or documented exposure to various microbial pathogens and reducing the risk of secondary spread of infection 3
- Guidelines for proper use of PEP have been published by the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices 3
Types of PEP
- Different forms of PEP are available, including vaccines, immune globulins, antibiotics, and antiviral medications 3
- The type of PEP used depends on the type of exposure, such as bloodborne pathogens, airborne or droplet spread, or direct contact 3
HIV Post-Exposure Prophylaxis
- Tenofovir DF/emtricitabine/rilpivirine is a recommended single-tablet regimen for HIV PEP 4
- A 28-day course of TDF/FTC/RPV is effective in preventing HIV seroconversion 4
- The CDC recommends antiretroviral PEP after sexual, injection drug use, or other non-occupational exposure to HIV 5
- The preferred regimens for most adults and adolescents are bictegravir/emtricitabine/tenofovir alafenamide or dolutegravir plus (tenofovir alafenamide or tenofovir disoproxil fumarate) plus (emtricitabine or lamivudine) 5
Safety and Tolerability of PEP Regimens
- Raltegravir, tenofovir DF, and emtricitabine may be a useful 3-drug regimen for PEP, with mild and self-limited side effects 6
- Tenofovir-emtricitabine is safe for HIV pre-exposure prophylaxis (PrEP) in individuals with active hepatitis B, with no evidence of hepatic flares or drug resistance 7