HIV post-exposure prophylaxis: Difference between revisions
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**Truvada (tenofovir 300 mg + emtricitabine 200 mg) 1 PO once daily | **Truvada (tenofovir 300 mg + emtricitabine 200 mg) 1 PO once daily | ||
*If known source patient with resistant HIV strain, consult HIV service for source-patient-specific PEP | *If known source patient with resistant HIV strain, consult HIV service for source-patient-specific PEP | ||
*At Harbor UCLA, patient will need to follow up in Employee Health ASAP (next business day) for needed blood draws and further counseling. | |||
*At Harbor UCLA, the ED pharmacist can assist you with acquiring an initial 2 week supply of Truvada and Raltegravir, to provide the patient prior to discharge. This is acquired from the inpatient pharmacy, located in the Harbor basement. | |||
^Consider interactions with current medication interactions and contraindications, such as renal impairment with Truvada | ^Consider interactions with current medication interactions and contraindications, such as renal impairment with Truvada | ||
Revision as of 19:19, 18 March 2015
Background
- Also known as HIV Post-Exposure Prophylaxis (PEP)
- ~79% transmission reduction
- Initiate ASAP (goal = <2 hours after exposure)
- >36 hours: normally deferred, unless particularly high risk
- Common side-effects = constitutional, gastrointestinal
National Clinician's Post-Exposure Prophylaxis Hotline
- 1-888-448-4911, call for expert advice
Diagnosis
Exposure Transmission Risk
| Exposure^ |
Risk |
| Percutaneous | 0.3% |
| Mucocutaneous | 0.09% |
| Needle-sharing injection drug | 0.7% |
| Receptive anal intercourse | 0.5% |
| Receptive penile-vaginal intercourse | 0.1% |
| Insertive anal intercourse | 0.07% |
| Insertive penile-vaginal intercourse | 0.05% |
| Receptive oral (male) intercourse | 0.01% |
| Insertive oral (male) intercourse | 0.005% |
^assumes no condom use
High Risk Exposures
Source
- Symptomatic HIV/AIDS
- Acute seroconversion
- High viral load
Exposure
- Deep injuries
- Visible blood on device
- Injuries sustained placing a catheter in a vein/artery
Workup (Before Giving)
- CBC
- C7
- LFTs
- Pregnancy test
Management
- CDC no longer recommends that the severity of exposure be used to determine the number of drugs to be offered and a regimen containing 3 antiretroviral drugs is now recommended routinely for all occupational exposures.[1]
Negligible Risk
- NOT recommended
Substantial Risk
- CDC preferred regimen for 28 days:^[2]
- Raltegravir (isentress) 400 mg PO twice daily, plus
- Truvada (tenofovir 300 mg + emtricitabine 200 mg) 1 PO once daily
- If known source patient with resistant HIV strain, consult HIV service for source-patient-specific PEP
- At Harbor UCLA, patient will need to follow up in Employee Health ASAP (next business day) for needed blood draws and further counseling.
- At Harbor UCLA, the ED pharmacist can assist you with acquiring an initial 2 week supply of Truvada and Raltegravir, to provide the patient prior to discharge. This is acquired from the inpatient pharmacy, located in the Harbor basement.
^Consider interactions with current medication interactions and contraindications, such as renal impairment with Truvada
Pregnant Patients
- Same as above
See Also
Source
- ↑ Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis. August 6, 2013. http://www.jstor.org/stable/10.1086/672271 DOI: 10.1086/672271
- ↑ Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis. August 6, 2013. http://www.jstor.org/stable/10.1086/672271 DOI: 10.1086/672271