From the Guidelines
The recommended Post-Exposure Prophylaxis (PEP) regimen for HIV exposure is a 3-drug regimen, which should be initiated as soon as possible after exposure, ideally within 72 hours, as recommended by the 2025 guidelines of the International Antiviral Society-USA panel 1.
Key Considerations
- The 3-drug PEP regimen is recommended for substantial HIV exposure within 72 hours, with the goal of preventing HIV infection by inhibiting viral replication at multiple stages.
- The choice of specific antiretroviral medications may depend on various factors, including the risk of transmission, potential resistance, and individual patient characteristics.
- Baseline HIV testing should be performed before starting PEP, with follow-up testing at 4-6 weeks and 3 months after exposure to monitor for potential seroconversion.
PEP Regimen
- A typical 3-drug PEP regimen may consist of tenofovir disoproxil fumarate (TDF) plus emtricitabine (FTC) combined with either dolutegravir or raltegravir, as recommended by the Centers for Disease Control and Prevention 1.
- The complete regimen must be taken for the full 28 days to maximize effectiveness, with ongoing monitoring for potential side effects and adherence to the treatment regimen.
Rationale
- The use of a 3-drug PEP regimen is supported by the most recent guidelines, which prioritize the prevention of HIV infection and the reduction of morbidity and mortality associated with HIV exposure 1.
- The choice of specific antiretroviral medications is based on their efficacy, safety, and potential for resistance, as well as their ability to inhibit viral replication at multiple stages of the HIV life cycle.
From the Research
Post-Exposure Prophylaxis (PEP) Regimens for HIV
The recommended PEP regimens for individuals exposed to Human Immunodeficiency Virus (HIV) are as follows:
- Tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC)/rilpivirine (RPV) as a single-tablet regimen, once daily for 28 days 2
- Elvitegravir/cobicistat/TDF/FTC as a single daily pill for 28 days 3
- Dolutegravir (DTG) with TDF-FTC as a three-drug PEP regimen, once daily for 28 days 4
Efficacy and Safety of PEP Regimens
These regimens have shown high completion rates and good tolerability, with minimal adverse events:
- TDF/FTC/RPV: 86.1% completion rate, with 69.6% of participants reporting at least one adverse event, mostly mild to moderate intensity 2
- Elvitegravir/cobicistat/TDF/FTC: 71% completion rate, with common side effects including abdominal discomfort, diarrhea, fatigue, and nausea 3
- DTG with TDF-FTC: 90% completion rate, with common adverse events including fatigue, nausea, diarrhea, and headache 4
Comparison of PEP Regimens
The choice of PEP regimen may depend on individual factors, such as medication tolerance and availability: