HIV PEP – Non-occupational

Preferred Regimen For Non-Occupational Post-Exposure Prophylaxis

Raltegravir 400mg PO Twice Daily

(Isentress®; RAL)

Plus

Truvada™,1 PO Once Daily

[Tenofovir DF (Viread®; TDF) 300mg + emtricitabine (Emtriva™; FTC) 200mg]

 

Summary of CDC Guidelines:
  • When care is sought ≤72 hours after a potential nonoccupational exposure that presents a substantial risk for HIV acquisition.
    • Obtain screening labs. Test exposed patient AND source patient (if possible)
      • HIV antibody/antigen
      • Hep B surface antigen, surface antibody, and core antibody
      • Hep C antibody
      • Syphilis
      • Gonorrhea
      • Chlamydia
      • Pregnancy
    • If rapid HIV blood test results are unavailable, and nPEP is otherwise indicated, it should be initiated without delay and can be discontinued if the patient is later determined to have HIV infection already or the source is determined not to have HIV infection.
  • nPEP is recommended when the source of the body fluids is known to be HIV-positive and the reported exposure presents a substantial risk for transmission.
  • nPEP is not recommended when the reported exposure presents no substantial risk of HIV transmission.
  • nPEP is not recommended when care is sought > 72 hours after potential exposure.
  • A case-by-case determination about the nPEP is recommended when the HIV infection status of the source of the body fluids is unknown and the reported exposure presents a substantial risk for transmission if the source did have HIV infection (see chart below)
  • Treatment is 28-day course of a 3-drug antiretroviral regimen for adults and adolescents > 12
    • Preferred
      • Raltegravir (Isentress®; RAL) 400mg PO Twice Daily AND Truvada™,1 PO Once Daily [Tenofovir DF (Viread®; TDF) 300mg + emtricitabine (Emtriva™; FTC) 200mg]
    • Alternative
      • tenofovir DF (300 mg) with emtricitabine (FTC) (200 mg) once daily plus darunavir (DRV) (800 mg) and ritonavira (RTV) (100 mg) once daily.
    • If creatinine clearance <59 mL/min, or if patient is 12 years or younger, see CDC document for alternate regimen. (pages 31-37 here)
  • All persons evaluated for possible nPEP should be provided any indicated prevention, treatment, or supportive care for other exposure-associated health risks and conditions (e.g., bacterial sexually transmitted infections, traumatic injuries, hepatitis B virus and hepatitis C virus infection, or pregnancy).
  • All persons who report behaviors or situations that place them at risk for frequently recurring HIV exposures (e.g., injection drug use, or sex without condoms) or who report receipt of ≥1 course of nPEP in the past year should be provided risk-reduction counseling and intervention services, including consideration of preexposure prophylaxis.

 

Source:

CDC 2016 guidelines

 

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