From the Guidelines
A standard Post-Exposure Prophylaxis (PEP) pack typically contains a 28-day supply of antiretroviral medications, usually consisting of tenofovir disoproxil fumarate (TDF) 300mg plus emtricitabine (FTC) 200mg (often combined as Truvada) taken once daily, along with either dolutegravir 50mg once daily or raltegravir 400mg twice daily, as recommended by the Centers for Disease Control and Prevention 1. The medications should be started as soon as possible after potential HIV exposure, ideally within 72 hours, and must be taken consistently for the full 28 days to maximize effectiveness.
- PEP works by preventing HIV from establishing infection in the body by inhibiting viral replication through different mechanisms.
- Side effects may include nausea, headache, and fatigue, but these typically resolve within the first week.
- Follow-up HIV testing is recommended at completion of the regimen and again at 3 months. Some regimens may alternatively use tenofovir alafenamide (TAF) instead of TDF, and other options like TDF/emtricitabine with boosted darunavir or TDF/emtricitabine/cobicistat/elvitegravir are also considered reasonable alternatives 1. It's essential to note that PEP is not 100% effective, so it's crucial to use additional prevention methods during and after the treatment period.
- The choice of regimen may depend on various factors, including the risk of drug resistance and the individual's medical history.
- Ongoing discussions about adherence are recommended, especially in the absence of proven PrEP adherence interventions 1. The most recent and highest quality studies support the use of these regimens, and they are recommended by reputable health organizations 1.
From the FDA Drug Label
Tenofovir disoproxil fumarate tablets are for oral administration. Each tablet contains 300 mg of tenofovir disoproxil fumarate, which is equivalent to 245 mg of tenofovir disoproxil The FDA drug label does not answer the question.
From the Research
Medications in the PEP Pack
The Post-Exposure Prophylaxis (PEP) pack typically contains a combination of antiretroviral medications to prevent HIV infection after potential exposure. The specific medications included in the PEP pack may vary, but common combinations are:
- Tenofovir disoproxil fumarate/emtricitabine plus ritonavir-boosted lopinavir or cobicistat-boosted elvitegravir 2
- Tenofovir disoproxil/emtricitabine plus either ritonavir-boosted lopinavir or raltegravir 3
Key Components
The key components of the PEP pack are:
- Nucleoside or nucleotide reverse transcriptase inhibitors (NtRTIs) such as tenofovir disoproxil fumarate/emtricitabine
- Protease inhibitors (PIs) such as ritonavir-boosted lopinavir or darunavir
- Integrase inhibitors (INSTIs) such as raltegravir or elvitegravir
Variations in PEP Regimens
Different studies have evaluated various PEP regimens, including:
- Lopinavir/ritonavir combined with raltegravir or tenofovir/emtricitabine 4
- Ritonavir-boosted darunavir combined with raltegravir or tenofovir-emtricitabine 5
- Starter packs versus full prescription of antiretroviral drugs for PEP 6
Considerations for PEP
When considering PEP, it is essential to note that the provision of starter packs may not improve adherence and may result in lower completion rates compared to full prescriptions 6. The choice of PEP regimen should be based on individual patient factors, potential drug interactions, and resistance patterns.