From the Guidelines
For adult healthcare providers exposed to HIV while working abroad, immediate initiation of post-exposure prophylaxis (PEP) is recommended, ideally within 72 hours of exposure, with a full 28-day prescription of antiretrovirals provided following initial risk assessment, as recommended by the World Health Organization 1. The preferred regimen is a three-drug combination, but the exact regimen may vary depending on availability and individual patient factors.
- Key considerations for PEP include:
- Initiating treatment as soon as possible after exposure
- Providing a full 28-day course of antiretrovirals
- Performing baseline HIV testing and follow-up testing at 6 weeks, 3 months, and 6 months post-exposure
- Contacting the institution's occupational health department for guidance and considering a PEP starter kit when traveling to areas with limited medical resources
- Potential side effects of PEP may include gastrointestinal symptoms, headache, and fatigue, but adherence to the full 28-day course is crucial for effectiveness, as supported by various studies 1.
- Upon return home, comprehensive follow-up care should be arranged with appropriate specialists to monitor for any potential complications or side effects.
From the Research
HIV Post-Exposure Prophylaxis (PEP) Protocol for Adults
The protocol for HIV Post-Exposure Prophylaxis (PEP) for adults when treating abroad involves the use of antiretroviral medications to prevent HIV infection after a high-risk exposure. The following are some key points to consider:
- The preferred regimen for HIV PEP is based mainly on safety and tolerability because it is given to immunocompetent people without HIV infection for a limited time (28 days) 2.
- Several studies have evaluated the safety and tolerability of different PEP regimens, including coformulated bictegravir, emtricitabine, and tenofovir alafenamide (BIC/FTC/TAF) 3, elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate (Stribild®) 2, tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC)/rilpivirine (RPV) 4, raltegravir, tenofovir DF, and emtricitabine 5, and dolutegravir with tenofovir disoproxil fumarate-emtricitabine (TDF-FTC) 6.
- These studies have shown that these regimens are generally well-tolerated and effective in preventing HIV infection, with high completion rates and few adverse events.
- The most common side effects reported in these studies included nausea or vomiting, fatigue, diarrhea, headache, and abdominal symptoms, which were typically mild and self-limited.
Key Considerations for PEP Regimens
Some key considerations for PEP regimens include:
- Safety and tolerability: The regimen should be safe and well-tolerated to ensure high completion rates and minimize adverse events.
- Efficacy: The regimen should be effective in preventing HIV infection.
- Ease of use: The regimen should be easy to use and adhere to, with a simple dosing schedule and minimal pill burden.
- Availability: The regimen should be available and accessible in the treatment setting.
Examples of PEP Regimens
Some examples of PEP regimens that have been evaluated in studies include:
- Coformulated BIC/FTC/TAF: This regimen has been shown to be safe, well-tolerated, and effective in preventing HIV infection, with a high completion rate of 90.4% 3.
- Stribild®: This regimen has been shown to be well-tolerated and effective in preventing HIV infection, with a high completion rate of 92% 2.
- TDF/FTC/RPV: This regimen has been shown to be safe and effective in preventing HIV infection, with a completion rate of 86.1% 4.
- Raltegravir, tenofovir DF, and emtricitabine: This regimen has been shown to be safe and effective in preventing HIV infection, with a completion rate of 57% 5.
- Dolutegravir with TDF-FTC: This regimen has been shown to be well-tolerated and effective in preventing HIV infection, with a completion rate of 90% 6.