Template:HIV post-exposure prophylaxis regimens: Difference between revisions
(/* Preferred HIV PEP RegimenKuhar D, et al. Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis. September 2013. 34(9):875-892. DOI: 1...)
 
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===2 drug Basic<ref name="NEJM">Landovitz RJ, Currier JS. Postexposure prophylaxis for HIV infection. N Eng J Med. 2009 Oct 29; 361(18): 1768-75. [http://www.uphs.upenn.edu/ppmc_emergency/PPMC%20Bookmarks/2012%20LLSA%20Articles/Postexposure%20Prophylaxis%20for%20HIV.pdf PDF]</ref>===
====Preferred HIV [[PEP]] Regimen<ref>Kuhar D, et al. Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis. September 2013. 34(9):875-892. DOI: 10.1086/672271. http://www.jstor.org/stable/10.1086/672271</ref><ref>Updated Guidelines for Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV—United States, 2016. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services</ref>====
*[[Tenofovir-emtricitabine]] (Truvada) one tablet (300 mg of tenofovir with 200 mg of emtricitabine) once daily OR
*[[Zidovudine–lamivudine]] (Combivir) one tablet (300 mg of zidovudine with 150 mg of lamivudine) twice daily
**this regimen is preferred in pregancy


===3 drug Expanded<ref name="NEJM"></ref>===
''PEP should be started as soon as possible after significant exposure and continued for 28 days''<ref>Kuhar DT et al. Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol. 2013 Sep;34(9):875-92. doi: 10.1086/672271.</ref>
*Ritonavir–lopinavir (Kaletra) PLUS either tenofovir–emtricitabine or zidovudine–lamivudine)
*[[Raltegravir]] (Isentress; RAL) 400 mg PO twice daily, '''plus'''
**Two tablets (50 mg of ritonavir with 200 mg of lopinavir per tablet) twice daily, or four tablets once daily
*[[Truvada]], 1 PO once daily (Tenofovir DF [Viread; TDF] 300 mg emtricitabine [Emtriva; FTC] 200 mg)
*Ritonavir plus atazanavir (plus either tenofovir–emtricitabine or zidovudine–lamivudine
 
**100 mg of ritonavir plus 300 mg of atazanavir once daily
'''Other Considerations'''
*Ritonavir plus darunavir (plus either tenofovir–emtricitabine or zidovudine–lamivudine)
*If known source patient with resistant HIV strain, consult HIV service for source-patient-specific PEP
**100 mg of ritonavir plus two tablets, each containing 400 mg of darunavir, once daily
*Consider interactions with current medication interactions and contraindications, such as renal impairment with [[Truvada]]
**For patients with creatinine clearance <60mL/min, consider [[Raltegravir]] 400mg PO twice daily, '''plus''' [[Zidovudine]] and [[Lamivudine]] with doses adjusted to the degree of renal dysfunction.<ref>Dominguez KL et al. Updated Guidelines for Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV--United States, 2016. Available at: https://stacks.cdc.gov/view/cdc/38856</ref>
*If the  source  exposure  does  report  exposure  to HIV  within the  last  6 weeks, HIV  RNA  PCR (HIV  viral  load)  should be  sent  along  with HIV  Ag/Ab screen on  the  source  and nPEP  should be  initiated for  the  exposed patient
**If  both tests  result  not  detected  and nonreactive, respectively, nPEP  should  be  discontinued.
**If the  source  is  willing  and  able  to be  tested and is  found to be  HIV-negative with  no  recent high-risk  exposures  to HIV, nPEP  is  not  indicated  and  should not  be  initiated, or discontinued if  already  started.
**The exposed  patient  still  warrants  baseline HIV  testing  and  should  be offered  baseline  and follow-up testing  for  other  transmissible  infections,  e.g. hepatitis  A, B, and C, syphilis, chlamydia, and gonorrhea.

Latest revision as of 00:15, 2 April 2022

Preferred HIV PEP Regimen[1][2]

PEP should be started as soon as possible after significant exposure and continued for 28 days[3]

  • Raltegravir (Isentress; RAL) 400 mg PO twice daily, plus
  • Truvada, 1 PO once daily (Tenofovir DF [Viread; TDF] 300 mg emtricitabine [Emtriva; FTC] 200 mg)

Other Considerations

  • If known source patient with resistant HIV strain, consult HIV service for source-patient-specific PEP
  • Consider interactions with current medication interactions and contraindications, such as renal impairment with Truvada
    • For patients with creatinine clearance <60mL/min, consider Raltegravir 400mg PO twice daily, plus Zidovudine and Lamivudine with doses adjusted to the degree of renal dysfunction.[4]
  • If the source exposure does report exposure to HIV within the last 6 weeks, HIV RNA PCR (HIV viral load) should be sent along with HIV Ag/Ab screen on the source and nPEP should be initiated for the exposed patient
    • If both tests result not detected and nonreactive, respectively, nPEP should be discontinued.
    • If the source is willing and able to be tested and is found to be HIV-negative with no recent high-risk exposures to HIV, nPEP is not indicated and should not be initiated, or discontinued if already started.
    • The exposed patient still warrants baseline HIV testing and should be offered baseline and follow-up testing for other transmissible infections, e.g. hepatitis A, B, and C, syphilis, chlamydia, and gonorrhea.
  1. ↑ Kuhar D, et al. Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis. September 2013. 34(9):875-892. DOI: 10.1086/672271. http://www.jstor.org/stable/10.1086/672271
  2. ↑ Updated Guidelines for Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV—United States, 2016. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services
  3. ↑ Kuhar DT et al. Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol. 2013 Sep;34(9):875-92. doi: 10.1086/672271.
  4. ↑ Dominguez KL et al. Updated Guidelines for Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV--United States, 2016. Available at: https://stacks.cdc.gov/view/cdc/38856
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