post-exposure HIV prophylaxis

Introduction

Prophylaxis for HIV exposure after:

• sexual activity
• sexual assault
• IV drug use

for needle stick, see prophylaxis after needle stick

Management

• risk of HIV transmission without prophylaxis is < 1%
• probably diminished further with prophylaxis
• prophylaxis must be started within 72 hours & continued for 28 days.
  • tenofovir/FTC, emtricitabine + raltegravir or dolutegravir
    • given for 4 weeks
    • not recommended if > 72 hours post-exposure
  • other recommendations
    • tenofovir/FTC, either alone or with lopinavir/ritonavir
      • adverse effects, particularly with lopinavir/ritonavir, often lead to early treatment discontinuation
    • alternative: tenofovir/FTC + twice-daily raltegravir
      • compliance with 2nd daily dose of raltegravir may be poor
      • MKSAP17 preferred regimen
  • see HIV1 infection for recommended regimens
  • recommendations for transitioning from post-exposure HIV prophylaxis to HIV preexposure prophylaxis

• check HIV status immediately after exposure & at 4-6 weeks, 3 months, & 6 months

For non-occupational exposure:

• risk of HIV conversion is 1% with post-exposure prophylaxis

Notes

• with Simian immunodeficiency virus in Rhesus macaques, a persistent viral reservoir is established before the onset of viremia; the same is thought for HIV1

More general terms

• prevention of HIV
• chemoprophylaxis

Additional terms

• pre-exposure HIV prophylaxis
• prophylaxis after needle stick; prophylaxis for blood-borne infection