Truvada Plus Raltegravir is an Acceptable PEP Regimen
You have a CDC-recommended post-exposure prophylaxis regimen: Truvada (tenofovir disoproxil fumarate/emtricitabine) plus raltegravir 400mg twice daily for 28 days is explicitly endorsed as a preferred option. 1, 2
Dosing Specifics
Administer Truvada (TDF 300mg/FTC 200mg) one tablet once daily PLUS raltegravir 400mg twice daily (every 12 hours) for a complete 28-day course 1, 2
Initiate this regimen immediately without waiting for source patient HIV confirmation or resistance testing results 1
The twice-daily dosing of raltegravir is critical—this is NOT the once-daily formulation 1
Timing and Initiation
Start PEP as soon as possible, ideally within 1-2 hours but up to 72 hours post-exposure for optimal effectiveness 2, 3
Even if you're approaching or slightly beyond the 72-hour window, initiate treatment for high-risk exposures as some benefit may still exist, particularly with well-tolerated modern regimens 3
Baseline Assessment Required
Obtain HIV antibody/antigen combination testing (ideally fourth-generation) before starting 1, 2
Check baseline serum creatinine with calculated creatinine clearance 2
Perform sexually transmitted infection screening (gonorrhea, chlamydia, syphilis) 1, 2
Pregnancy test for individuals of childbearing potential 1, 2
Follow-Up HIV Testing Schedule
Reassess HIV serostatus at 4-6 weeks, 3 months, and 6 months after exposure 1, 2
If using a fourth-generation assay, shorter serologic follow-up at 3-4 months may be acceptable 1
Discontinue PEP if the source patient is confirmed HIV-negative at any point 3
Important Clinical Caveats
Adherence is absolutely critical—counsel the patient that missing doses significantly reduces efficacy 2
The twice-daily raltegravir dosing can be challenging; consider setting phone alarms or using pill organizers 1
Monitor for gastrointestinal side effects (nausea, diarrhea) and headache, though this regimen is generally well-tolerated 4
Raltegravir requires administration without regard to food, while Truvada can be taken with or without food 1
Transition Consideration
- For individuals with repeated PEP requests or ongoing high-risk exposures, transition to daily PrEP (Truvada once daily) after completing the 28-day PEP course, as continuous PrEP may provide superior protection compared to episodic PEP 1, 2
Why This Regimen Works
While newer single-tablet regimens like bictegravir/emtricitabine/tenofovir alafenamide show higher completion rates (90-96%) 5, 6, your available combination of Truvada plus twice-daily raltegravir remains a CDC-preferred option with established efficacy 1, 2
The combination provides coverage against wild-type HIV with minimal resistance concerns when used for PEP 1