From the Guidelines
The recommended Post-Exposure Prophylaxis (PEP) regimen for unpregnant women is a 28-day course of three antiretroviral medications, which should be initiated as soon as possible after potential HIV exposure, ideally within 72 hours. The most recent and highest quality study 1 provides guidelines for the management of occupational exposures to HIV and recommendations for postexposure prophylaxis, emphasizing the importance of starting PEP as soon as possible after an exposure and administering it for 4 weeks if tolerated. Key considerations for PEP include:
- Initiating treatment as soon as possible after exposure, with effectiveness decreasing with delayed administration
- Baseline HIV testing before starting PEP, with follow-up testing at 4-6 weeks and 3 months post-exposure
- Monitoring for medication side effects and providing adherence support throughout the treatment period
- Selecting a PEP regimen based on the comparative risk represented by the exposure and information about the exposure source, including history of and response to antiretroviral therapy 1. However, the older study 1 is less relevant due to its age and the evolution of antiretroviral therapy, thus the most recent guidelines 1 should be prioritized. The combination of drugs used in PEP targets different phases of the HIV life cycle, preventing viral replication and integration into host cells. Regular monitoring and adherence support are crucial to ensure the effectiveness of PEP and minimize potential side effects, such as nausea, fatigue, and headache.
From the Research
Post-Exposure Prophylaxis (PEP) Regimen for Unpregnant Women
The recommended PEP regimen for unpregnant women is as follows:
- The preferred regimens for most adults and adolescents are now bictegravir/emtricitabine/tenofovir alafenamide or dolutegravir plus (tenofovir alafenamide or tenofovir disoproxil fumarate) plus (emtricitabine or lamivudine) 2
- However, the regimen can be tailored to the clinical circumstances
- Coformulated bictegravir, emtricitabine, and tenofovir alafenamide (BIC/FTC/TAF) is also effective for PEP and has been found to be safe, well-tolerated, and highly acceptable when used for PEP 3
- Tenofovir DF/emtricitabine/rilpivirine is another option for HIV post-exposure prophylaxis, with good tolerability and no documented HIV seroconversion 4
Key Considerations
- 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, 4
- 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