HIV post-exposure prophylaxis

Background

• Also known as Post-Exposure Prophylaxis (PEP)
• ~79% transmission reduction
• Initiate ASAP (goal = 1-2 hours)
• >36 hours: normally deferred, unless particularly high risk
• Common side-effects = constitutional, gastrointestinal

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

1. Symptomatic HIV/AIDS
2. Acute seroconversion
3. High viral load

Exposure

1. Deep injuries
2. Visible blood on device
3. Injuries sustained placing a catheter in a vein/artery

Workup (Before Giving)

• CBC
• C7
• LFTs
• Pregnancy test

Regimens (CDC)

1. Basic (2-Drug)
   1. Tenofovir-Emtricitabine 300mg/200mg (Truvada): 1 tab PO QD
   2. OR, Zidovudine-Lamivudine 300mg/150mg (Combivir)^: 1 tab PO BID
2. Expanded (3-Drug)
   1. Ritonavir-Lopinavir 50mg/200mg(Kaletra): 2 tabs PO BID
      1. PLUS tenofovir-emtricitabine OR zidovudine-lamivudine

^Prefered in pregnancy

National HIV/AIDS Clinicians' Consultation Center: 888-448-4911

Treatment

Negligible Risk

1. Urine, nasal secretions, saliva, sweat or tears not visibly contaminated with blood
2. HIV Post-Exposure Prophylaxis not recommended

Substantial Risk

1. Exposure of vagina, rectum, eye, mouth or other mucous membrane, non-intact skin, or percutaneous contact
2. With blood, semen, vaginal secretions, rectal secretions, breast milk, or any body fluid visibly contaminated with blood
   1. <72 Hours
      1. Source = Unknown HIV
         1. -->Case-by-case determination
      2. Source = Known HIV+
         1. -->28-day course of HAART
            1. (three-drug regimen), start ASAP
   2. >72 Hours
      1. -->No HAART recommended

National Clinician's Post-Exposure Prophylaxis Hotline

• 1-888-448-4911, call for expert advice

HIV

• Consider Post Exposure Prophylaxis (PEP)
• Initiate within 72h (best within 36h) x 28d
• Zidovudine 300mg bid or 200mg tid + Lamivudine 150mg bid

OR

• Tenofovir + Emtricitabine

See Also

• Occupational exposure
• Sexual assault