From the Guidelines
Post-exposure prophylaxis (PEP) after a needlestick injury should be initiated as soon as possible, ideally within 1-2 hours but no later than 72 hours after exposure, as recommended by the most recent guidelines 1. The standard regimen consists of a three-drug combination, which should be continued for 28 days. Before starting PEP, baseline HIV, hepatitis B, and hepatitis C testing should be performed on both the exposed person and the source patient if possible. The exposed person should also have baseline complete blood count, liver and kidney function tests. Some key points to consider when administering PEP include:
- The risk of HIV transmission from a needlestick is approximately 0.3% from a known HIV-positive source, but this risk increases with deep injuries, visible blood on the device, procedures involving needles placed in arteries or veins, and high viral load in the source patient 2, 3.
- Side effects of PEP medications may include nausea, fatigue, and headache, which can be managed symptomatically.
- Counseling and support should be provided throughout the PEP course.
- Follow-up HIV testing should occur at 6 weeks, 3 months, and 6 months post-exposure, as recommended by the guidelines 4. 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, as well as other considerations such as pregnancy in the healthcare worker and exposure to virus known or suspected to be resistant to antiretroviral drugs 5. Overall, the goal of PEP is to prevent HIV infection after a potential exposure, and it is most effective when started immediately.
From the Research
Post Exposure Needle Prophylaxis
- Post-exposure prophylaxis (PEP) is the use of short-term antiretroviral therapy (ART) to reduce the risk of acquisition of HIV infection following exposure 6
- Current guidelines recommend a 28-day course of ART within 36-72 hours of exposure to HIV 6
- Nonoccupational PEP, the vast majority of which is for sexual exposure (PEPSE), has a significant role to play in HIV prevention efforts 6
Efficacy of PEP Regimens
- A study evaluated a novel 3-drug PEP regimen, consisting of raltegravir, tenofovir DF, and emtricitabine, and found that 57% of participants completed the regimen as prescribed, and 27% took their medicine daily, but sometimes missed the second daily dose of Raltegravir 7
- The most common side effects reported included nausea or vomiting, diarrhea, headache, fatigue, abdominal symptoms, and myalgias or arthralgias, all of which were mild and tended to be self-limited, not resulting in drug discontinuation 7
- Another study compared a once daily formulation of raltegravir to the currently marketed twice daily formulation, and found that a once daily raltegravir 1200 mg regimen was non-inferior compared with raltegravir 400 mg twice daily for initial treatment of HIV-1 infection 8
Comparison of PEP Regimens
- A study compared emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis, and found that emtricitabine and tenofovir alafenamide was non-inferior to emtricitabine and tenofovir disoproxil fumarate for HIV prevention, and had more favourable effects on bone mineral density and biomarkers of renal safety 9
- A follow-up study found that emtricitabine and tenofovir alafenamide maintained its non-inferiority to emtricitabine and tenofovir disoproxil fumarate for HIV prevention at 96 weeks, and continued to show superiority over emtricitabine and tenofovir disoproxil fumarate in all but one of the six prespecified bone mineral density and renal biomarkers 10