From the Guidelines
The recommended dosing regimen for Post-Exposure Prophylaxis (PEP) for Human Immunodeficiency Virus (HIV) is a 28-day course of a 3-drug regimen, such as tenofovir disoproxil fumarate/emtricitabine plus twice-daily raltegravir or once-daily dolutegravir.
Key Considerations
- The choice of regimen should be based on the individual's medical history, potential drug interactions, and the risk of resistance in the exposure source 1.
- A 2-drug regimen may be considered in situations where a 3-drug regimen is not available or where the risk of additional toxicity outweighs the benefit 1.
- The Centers for Disease Control and Prevention recommend the following regimens for PEP: tenofovir disoproxil fumarate/emtricitabine plus twice-daily raltegravir or once-daily dolutegravir, or tenofovir disoproxil fumarate/emtricitabine with cobicistat- or ritonavir-boosted darunavir, or tenofovir disoproxil fumarate/emtricitabine/cobicistat/elvitegravir 1.
Important Details
- PEP should be started as soon as possible after exposure, without waiting for confirmation of HIV serostatus of the source patient or results of HIV RNA or resistance testing 1.
- HIV serostatus should be reassessed at 4 to 6 weeks, 3 months, and 6 months after exposure, with shorter follow-up possible with a fourth-generation assay 1.
- The World Health Organization guidelines recommend a public health approach to delivering HIV services, aiming for a balance between best proven standard of care and feasibility, and simplifying prescribing and aligning regimens for PEP with those currently used for antiretroviral therapy (ART) 1.
From the Research
Post-Exposure Prophylaxis (PEP) for Human Immunodeficiency Virus (HIV)
- The exact dosing regimen for PEP is a 28-day course of antiretroviral therapy (ART) within 36-72 hours of exposure to HIV 2.
- The recommended regimen includes a combination of antiretroviral agents, such as elvitegravir/cobicistat/tenofovir disoproxil fumarate/emtricitabine (Quad pill) 3.
- This regimen has been shown to be safe and well-tolerated, with higher completion rates compared to more frequently dosed regimens 3.
- The use of PEP has been extended to nonoccupational exposures, including after sexual contact or injection-drug use 4, 2.
- Current guidelines recommend the use of PEP to reduce the risk of acquisition of HIV infection following exposure, with an assumed efficacy of at least 80% 5.
Key Considerations
- Awareness of PEP and its availability for both clinicians and those who are eligible to receive it are crucial to ensure that PEP is used to its full potential in any HIV prevention strategy 2.
- The initial evaluation of an exposed individual and follow-up during and after treatment are important aspects of PEP 5.
- Adherence to the PEP regimen is critical, and interventions to improve adherence may be necessary 6.