Initiate PEP for Exposures Posing Risk of HIV Transmission

PEP should be initiated as soon as possible, preferably within 72 hours after a possible exposure to HIV.¹⁹ This recommendation is based on evidence that following primary exposure systemic infection does not occur immediately, leaving a brief window of opportunity during which PEP might limit the proliferation of HIV in initial target cells or lymph nodes. In a retrospective case-control study of HCP, PEP with zidovudine reduced the risk of HIV infection by approximately 81%.¹⁸ The Centers For Disease Control and Prevention website offers PeP locator service.

The U.S. Public Health Service no longer recommends that the severity of exposure be used to determine the number of drugs to be offered in an HIV PEP regimen.¹⁹

When deemed necessary, a 28 day PEP medication regimen should contain 3 (or more) antiretroviral drugs and be initiated. As of 2025, the recommended PEP includes Integrase Strand Transfer Inhibitors PLUS Two Nucleoside Reverse Transcriptase Inhibitors. The preferred regimen for healthy HCP is Bictegravir/emtricitabine/tenofovir alafenamide, Dolutegravir PLUS (tenofovir alafenamide OR tenofovir disoproxil fumarate) PLUS emtricitabine OR lamivudine. Alternatives exist to accommodate existing health conditions, antiviral resistance or pregnancy.