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 A basic 4 week PEP regimen containing 3 (or more) antiretroviral drugs is now routinely prescribed following all occupational exposures. The preferred regimen is: Raltegravir (Isentress®; RAL) 400mg PO Twice Daily plus Truvada™, 1 PO Once Daily [Tenofovir DF (Viread®; TDF) 300mg + emtricitabine (Emtriva™; FTC) 200mg]. Alternative regimen combinations are available to include a the single fixed-dose combination regimen: Stribild™ (elvitegravir, cobicistat, tenofovir DF, emtricitabine). Prescribers should be familiar with the agents and their toxicities.19