From the Guidelines
Post-exposure prophylaxis (PEP) for HIV should consist of a 28-day course of three antiretroviral medications, typically tenofovir disoproxil fumarate plus emtricitabine (Truvada) combined with either dolutegravir or raltegravir, initiated as soon as possible, ideally within 72 hours of exposure, as recommended by the most recent guidelines 1. For individuals exposed to serious diseases such as Human Immunodeficiency Virus (HIV), the recommended PEP regimen is a 3-drug regimen, which is consistent with recommendations for treatment, the standard for which is triple-combination therapy 1. The decision to recommend HIV postexposure prophylaxis must take into account the nature of the exposure and the amount of blood or body fluid involved in the exposure, as well as other considerations such as pregnancy in the exposed individual and exposure to virus known or suspected to be resistant to antiretroviral drugs 1. Key points to consider when administering PEP include:
- The timing of initiation, with treatment beginning as soon as possible, ideally within 72 hours of exposure, as effectiveness decreases significantly after this window 1.
- The selection of the PEP regimen, which should consider the comparative risk represented by the exposure and information about the exposure source, including history of and response to antiretroviral therapy based on clinical response, CD4+ T-lymphocyte counts, viral load measurements, and current disease stage 1.
- The importance of immediate medical attention, as delays can significantly reduce effectiveness, and healthcare providers may adjust regimens based on exposure severity and individual factors 1. For rabies and hepatitis B, the PEP regimens include thorough wound cleansing, administration of immune globulin, and vaccination, with the specific details of the regimen depending on the disease and the individual's vaccination history. In all cases, immediate medical attention is crucial, and healthcare providers should adjust regimens based on exposure severity and individual factors.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Post-Exposure Prophylaxis (PEP) Regimens
The recommended PEP regimens for individuals exposed to serious diseases such as Human Immunodeficiency Virus (HIV) are as follows:
- For HIV exposure, 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) 2
- A 3-drug PEP regimen consisting of raltegravir, tenofovir DF, and emtricitabine has been evaluated and found to be safe and tolerable, with high adherence rates 3
- Newer PEP regimens, particularly those containing integrase strand transfer inhibitors (INSTIs) combined with a tenofovir and lamivudine or emtricitabine backbone, have been established as safe and tolerable 4
Administration and Follow-up
- The first dose of PEP should be provided as soon as possible, and ideally within 24 hours, but no later than 72 hours after exposure 2
- The recommended length of PEP course is 28 days 2
- Medical follow-up for persons prescribed PEP should be tailored to the clinical situation, with recommended follow-up including a visit at 24 hours and clinical follow-up 4-6 weeks and 12 weeks after exposure for laboratory testing 2
Considerations for PEP Use
- PEP can be used to prevent HIV transmission after high-risk sexual exposures, and its use has been recommended for over three decades 5, 4
- PEP seems to be underused globally, and links to other prevention services are suboptimal 4
- Interventions to increase provider and community awareness of PEP are needed 4
- Nurse practitioners play an essential role in managing treatment for people exposed to HIV and following up on these patients' response and adherence to the treatment protocol 6