From the Guidelines
The recommended post-exposure prophylaxis (PEP) regimen for potential HIV exposure is a 28-day course of highly active antiretroviral therapy (HAART), which should be initiated as soon as possible after exposure, ideally within 72 hours. The decision to recommend HIV postexposure prophylaxis must take into account the nature of the exposure and the amount of blood or body fluid involved in the exposure 1. Key considerations include:
- The nature of the exposure, such as needlestick or potentially infectious fluid that comes in contact with a mucous membrane
- The amount of blood or body fluid involved in the exposure
- Pregnancy in the exposed individual and exposure to virus known or suspected to be resistant to antiretroviral drugs
- Assessments of the risk for infection resulting from the exposure and of the infectivity of the exposure source For persons seeking care <72 hours after nonoccupational exposure to blood, genital secretions, or other potentially infectious body fluids of a person known to be HIV infected, when that exposure represents a substantial risk for transmission, a 28-day course of HAART is recommended 1. Common side effects of PEP can include nausea, fatigue, and headache, which can be managed symptomatically. Adherence to the full 28-day course is crucial for effectiveness. PEP works by preventing viral replication during the early stages of infection before HIV establishes itself permanently in the body. The regimen targets different stages of the viral life cycle, providing comprehensive protection against potential infection. Baseline HIV testing is required before starting PEP, with follow-up testing at 4-6 weeks and 3 months post-exposure. Risk-reduction counseling and indicated intervention services should be provided to reduce the risk for recurrent exposures 1.
From the Research
Post-Exposure Prophylaxis (PEP) Regimen
The recommended post-exposure prophylaxis (PEP) regimen for potential Human Immunodeficiency Virus (HIV) exposure is as follows:
- Initiation of therapy in a timely fashion with combination antiretroviral agents is essential 2
- Careful follow-up including medication monitoring, HIV antibody testing, and supportive counseling are an integral part of PEP therapy 2
- Recommended medications should be available in emergency rooms and employee health clinics for this purpose 2
Effectiveness of PEP
- PEP is likely to reduce the risk of infection from HIV exposure in health care workers, though data confirming this is limited 2
- PEP is not completely protective, and seroconversion may result from antiretroviral failure or from ongoing exposures 3
- PEP associated risk reduction counseling results in reductions in subsequent risk behavior 3
Antiretroviral Options
- The ideal antiretrovirals for PEP use have not been established 3
- Tenofovir has several attractive properties for use in PEP 3
Real-World Experience
- A study of two major AIDS centers found that PEP was effective and safe in preventing HIV infection after potential exposure 4
- The study found that in potential occupational exposure to HIV, it is possible to assess the risk for infection sufficiently so that only a few cases will need PEP 4
- In potential sexual exposure to HIV, there are many cases where data regarding the potential source of infection is partial or missing, making the risk assessment more difficult 4