What is the postexposure prophylaxis (PEP) treatment for Human Immunodeficiency Virus (HIV)?

From the Guidelines

Postexposure prophylaxis (PEP) for HIV should be initiated with a 3-drug regimen as soon as possible after substantial exposure, ideally within 72 hours, as recommended by the international antiviral society-usa panel in 2024 1. The goal of PEP is to prevent HIV infection after potential exposure, and it is most effective when started promptly.

• Key considerations for PEP include:
  • Initiating treatment within 72 hours of exposure
  • Using a 3-drug antiretroviral regimen
  • Monitoring for side effects and managing them symptomatically
  • Accompanying PEP with HIV testing at baseline, 4-6 weeks, and 3 months after exposure
• The recommended regimen may vary depending on individual factors, such as pregnancy or kidney disease, but the core principle of initiating a 3-drug PEP regimen as soon as possible after exposure remains the same, as emphasized in the 2025 study published in JAMA 1.
• It is crucial for individuals who have been potentially exposed to HIV to seek immediate medical attention for PEP evaluation, regardless of the perceived risk level, to maximize the effectiveness of the treatment.
• The use of PEP has been shown to be effective in preventing HIV infection when initiated promptly, and it is a critical component of HIV prevention strategies, as highlighted by the international antiviral society-usa panel's 2024 recommendations 1.

From the Research

Postexposure Prophylaxis (PEP) Treatment for HIV

The postexposure prophylaxis (PEP) treatment for Human Immunodeficiency Virus (HIV) involves the use of antiretroviral drugs to prevent HIV infection after exposure. The following are key points to consider:

• PEP is recommended when a nonoccupational exposure to HIV has occurred, and the source has HIV without sustained viral suppression or their viral suppression information is not known 2.
• A rapid HIV test or laboratory-based antigen/antibody combination HIV test is recommended before PEP initiation 2.
• 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.

PEP Regimens

The preferred regimens for most adults and adolescents are:

• Bictegravir/emtricitabine/tenofovir alafenamide
• Dolutegravir plus (tenofovir alafenamide or tenofovir disoproxil fumarate) plus (emtricitabine or lamivudine) 2.
• Raltegravir, tenofovir DF, and emtricitabine may be useful as a 3-drug regimen for PEP 3, 4.

Adherence and Safety

• High levels of adherence to PEP regimens have been reported, with completion rates of 92% and medication adherence rates of 89% 4.
• Common side effects of PEP regimens include nausea, diarrhea, headache, fatigue, and abdominal symptoms, but these are generally mild and self-limited 3, 4.
• Raltegravir-emtricitabine-tenofovir has been shown to be well tolerated as NPEP, with high levels of adherence and few potential drug-drug interactions 4.

Follow-up and Testing

• 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.
• Persons initiating PEP should be informed that pre-exposure prophylaxis for HIV (PrEP) can reduce their risk for acquiring HIV if they will have repeat or continuing exposure to HIV after the end of the PEP course 2.