What are the post-exposure prophylaxis (PEP) recommendations for Human Immunodeficiency Virus (HIV) following a percutaneous (needle stick) injury?

From the Guidelines

Post-exposure prophylaxis (PEP) for HIV after a needle stick injury should be started as soon as possible, ideally within 2 hours and no later than 72 hours after exposure. The recommended regimen is:

• Tenofovir disoproxil fumarate (TDF) 300 mg + Emtricitabine (FTC) 200 mg once daily
• Plus Dolutegravir 50 mg once daily This three-drug regimen should be taken for 28 days. Additional important steps:

• Immediately wash the exposed area with soap and water
• Report the incident to occupational health or emergency department
• Get tested for HIV at baseline and follow-up at 6 weeks, 3 months, and 6 months
• Assess the source patient's HIV status if possible PEP is highly effective when started promptly, as supported by a case-control study of needlestick injuries to health-care workers, which showed an 81% decrease in the risk for acquiring HIV with the prompt initiation of zidovudine 1. The medications work by preventing HIV from establishing infection in the body. TDF and FTC block viral replication, while Dolutegravir inhibits viral integration into host cells. This combination provides a potent barrier against HIV infection. It is crucial to consider the comparative risk represented by the exposure and information regarding the exposure source, including history of and response to antiretroviral therapy based on clinical response, CD4+ T-cell counts, viral load measurements, and current disease stage 1. If the source person's virus is known or suspected to be resistant to one or more of the drugs considered for the PEP regimen, the selection of drugs to which the source person's virus is unlikely to be resistant is recommended; expert consultation is advised. Side effects may include nausea, fatigue, and headache. Adherence to the full 28-day course is crucial for maximum effectiveness. Counseling and support should be provided to ensure completion of the regimen.

From the Research

Post-Exposure Prophylaxis (PEP) Recommendations for HIV

• The recommended PEP regimens for HIV include coformulated bictegravir, emtricitabine, and tenofovir alafenamide (BIC/FTC/TAF) 2, tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC)/rilpivirine (RPV) 3, raltegravir, tenofovir DF, and emtricitabine 4, elvitegravir/cobicistat/tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) 5, and dolutegravir with tenofovir disoproxil fumarate-emtricitabine (TDF-FTC) 6.
• These regimens have been shown to be safe, well-tolerated, and effective in preventing HIV infection after high-risk exposures.
• The most common side effects reported with these regimens include nausea or vomiting, fatigue, diarrhea, headache, and abdominal symptoms, but these are generally mild and self-limited 2, 3, 4, 5, 6.

Regimen Completion Rates

• Regimen completion rates vary among the different PEP regimens, with the coformulated BIC/FTC/TAF regimen showing a completion rate of 90.4% 2.
• The TDF/FTC/RPV regimen had a completion rate of 86.1% 3.
• The raltegravir, tenofovir DF, and emtricitabine regimen had a completion rate of 57% 4.
• The elvitegravir/cobicistat/TDF/FTC regimen had a completion rate of 71% 5.
• The dolutegravir with TDF-FTC regimen had a completion rate of 90% 6.

Adherence and Safety

• Adherence to PEP regimens is crucial for their effectiveness, and the use of single-tablet regimens has been shown to improve adherence 2, 5, 6.
• The safety profiles of these regimens are generally favorable, with few serious adverse events reported 2, 3, 4, 5, 6.