From the Guidelines
The recommended post-exposure prophylaxis (PEP) regimen for HIV exposure is a 28-day course of three antiretroviral medications, typically consisting of tenofovir disoproxil fumarate (TDF) 300mg plus emtricitabine (FTC) 200mg once daily, combined with either dolutegravir 50mg once daily or raltegravir 400mg twice daily, as recommended by the most recent guidelines 1.
Key Considerations
- PEP should be initiated as soon as possible after exposure, ideally within 72 hours, as effectiveness decreases with delayed administration.
- The exposed individual should undergo baseline HIV testing before starting PEP, with follow-up testing at 4-6 weeks and 3 months post-exposure.
- Common side effects include nausea, fatigue, and headache, which can be managed symptomatically.
- Adherence to the full 28-day regimen is crucial for effectiveness.
- PEP works by preventing viral replication during the early stages of infection before HIV becomes permanently established in the body.
Additional Recommendations
- The exposed individual should receive counseling about safer practices to prevent future exposures and should be evaluated for other sexually transmitted infections if the exposure was sexual in nature.
- If pregnancy is possible, a pregnancy test should be performed before starting PEP.
- The selection of drugs for PEP should consider the potential for antiretroviral drug resistance in the exposure source, and expert consultation is advised if necessary 1.
- Postexposure prophylaxis regimens should be continued for 28 days, and HIV serostatus should be reassessed at 4 to 6 weeks, 3 months, and 6 months after exposure 1.
From the Research
Post-Exposure Prophylaxis (PEP) Regimens for HIV
The recommended PEP regimen for individuals exposed to Human Immunodeficiency Virus (HIV) is based on safety and tolerability, as it is given to immunocompetent people without HIV infection for a limited time (28 days) 2.
Current Guidelines and Recommendations
Current guidelines recommend a 28-day course of antiretroviral therapy (ART) within 36-72 hours of exposure to HIV 3. The Centers for Disease Control and Prevention (CDC) recommends nonoccupational postexposure prophylaxis (nPEP) for HIV when a nonoccupational exposure to nonintact skin or mucous membranes that presents a substantial risk for HIV transmission has occurred, and the source has HIV without sustained viral suppression or their viral suppression information is not known 4.
Preferred Regimens
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) 4. Other regimens, such as coformulated bictegravir, emtricitabine, and tenofovir alafenamide, have also been found to be safe, well-tolerated, and highly acceptable when used for PEP 5. Tenofovir DF/emtricitabine/rilpivirine has also been recommended as HIV post-exposure prophylaxis, with few data supporting this usage 6.
Key Considerations
- A rapid HIV test or laboratory-based antigen/antibody combination HIV test is recommended before nPEP initiation 4.
- The first dose of nPEP should be provided as soon as possible, and ideally within 24 hours, but no later than 72 hours after exposure 4.
- Medical follow-up for persons prescribed nPEP 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 4.
- Persons initiating nPEP 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 nPEP course 4.
Common Side Effects
Common side effects of PEP regimens include: