From the Guidelines
Post-exposure prophylaxis (PEP) for HIV should be initiated as soon as possible, ideally within 72 hours, with a recommended regimen of three antiretroviral medications taken for 28 days, such as tenofovir disoproxil fumarate (TDF) 300mg plus emtricitabine (FTC) 200mg once daily, combined with either raltegravir 400mg twice daily or dolutegravir 50mg once daily 1.
Key Considerations
- PEP should be offered to individuals with exposures that have the potential for HIV transmission, including bodily fluids, mucous membrane, and parenteral exposures 1.
- Eligibility assessment should be based on the HIV status of the source whenever possible and may include consideration of background prevalence and local epidemiological patterns 1.
- Exposures that do not require HIV PEP include when the exposed individual is already HIV positive, when the source is established to be HIV negative, or when the exposure does not pose a significant risk 1.
PEP Regimen
- The recommended PEP regimen consists of three antiretroviral medications taken for 28 days 1.
- Common regimens include TDF 300mg plus FTC 200mg once daily, combined with either raltegravir 400mg twice daily or dolutegravir 50mg once daily 1.
Timing and Effectiveness
- PEP should be started as soon as possible after exposure, ideally within 2 hours, as effectiveness decreases with time 1.
- Although PEP is ideally provided within 72 hours of exposure, providers should consider the range of other essential interventions and referrals that should be offered to clients presenting after the 72-hour period 1.
Monitoring and Follow-up
- During treatment, avoid unprotected sex and follow up with healthcare providers for HIV testing at baseline, 4-6 weeks, and 3 months after exposure 1.
- PEP works by preventing HIV from establishing infection in the body by inhibiting viral replication at multiple stages 1.
Important Notes
- If you believe you've been exposed to HIV, seek medical attention immediately as timing is critical for PEP effectiveness 1.
- In cases that do not require PEP, the exposed person should be counseled about limiting future exposure risk 1.
From the Research
Post-Exposure Prophylaxis (PEP) Options for Human Immunodeficiency Virus (HIV)
- PEP is recommended to prevent HIV infection after a high-risk exposure, with various antiretroviral regimens available 2, 3, 4, 5, 6
- Coformulated bictegravir, emtricitabine, and tenofovir alafenamide (BIC/FTC/TAF) has been evaluated as a PEP option, showing safety, tolerability, and high completion rates 2, 5
- Tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC)/rilpivirine (RPV) is another single-tablet regimen recommended for PEP, with studies demonstrating its tolerability and effectiveness 4
- Other PEP regimens, such as tenofovir/emtricitabine and lopinavir/ritonavir tablet formulation (TDF/FTC+LPV/r), have also been studied, with varying rates of tolerability and completion 6
- The choice of PEP regimen may depend on individual factors, such as potential drug-drug interactions and side effect profiles 3, 6
Common PEP Regimens
- BIC/FTC/TAF: a single-tablet regimen with a high completion rate and few side effects 2, 5
- TDF/FTC/RPV: a single-tablet regimen with good tolerability and no documented HIV seroconversions 4
- TDF/FTC+LPV/r: a regimen with a lower dropout rate due to adverse events compared to other regimens 6