post-exposure HIV prophylaxis
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Introduction
Prophylaxis for HIV exposure after:
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.
- bictegravir/FTC/TAF (CDC)[12]
- dolutegravir plus TAF or TDF plus FTC or 3TC (CDC)[12]
- tenofovir/FTC, emtricitabine + raltegravir or dolutegravir[5]
- 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[6]
- compliance with 2nd daily dose of raltegravir may be poor
- MKSAP17 preferred regimen[5]
- tenofovir/FTC, either alone or with lopinavir/ritonavir
- see HIV1 infection for recommended treatment regimens
- recommendations for transitioning from post-exposure HIV prophylaxis to HIV preexposure prophylaxis[10]
- check HIV status immediately after exposure & at 4-6 weeks, 3 months, & 6 months
- check HIV status using Ag/Ab & nucleic acid testing, at week 12
- if started post-exppsure prophylaxis >24 hours after exposure or missed doses, interim testing is recommended 4-6 weeks postexposure[13]
For non-occupational exposure:
- risk of HIV conversion is 1% with post-exposure prophylaxis[3]
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[8]
More general terms
Additional terms
References
- ↑ Prescriber's Letter 12(3): 2005 Antiretroviral Postexposure Prophylaxis After Nonoccupational Exposure to HIV Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210307&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Journal Watch 25(5):42, 2005 Smith DK, Grohskopf LA, Black RJ, Auerbach JD, Veronese F, Struble KA, Cheever L, Johnson M, Paxton LA, Onorato IM, Greenberg AE; U.S. Department of Health and Human Services. Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: recommendations from the U.S. Department of Health and Human Services. MMWR Recomm Rep. 2005 Jan 21;54(RR-2):1-20. <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/15660015 <Internet> http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm
- ↑ 3.0 3.1 Roland ME et al, Seroconversion following nonoccupational postexposure prophylaxis against HIV Clin Infect Dis 41:1507, 2005 PMID: https://pubmed.ncbi.nlm.nih.gov/16231265
- ↑ Paltiel AD et al HIV preexposure prophylaxis in the United States: Impact on lifetime infection risk, clinical outcomes, and cost-effectiveness. Clin Infect Dis 2009 Mar 15; 48:806. PMID: https://pubmed.ncbi.nlm.nih.gov/19193111
- ↑ 5.0 5.1 5.2 Medical Knowledge Self Assessment Program (MKSAP) 14, 17, 18. American College of Physicians, Philadelphia 2006, 2015, 2018.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 6.0 6.1 Mayer KH et al. Raltegravir, tenofovir DF, and emtricitabine for postexposure prophylaxis to prevent the sexual transmission of HIV: Safety, tolerability and adherence. J Acquir Immune Defic Syndr 2012 Apr 1; 59:354. PMID: https://pubmed.ncbi.nlm.nih.gov/22267017
- ↑ Landovitz RJ, Currier JS. Clinical practice. Postexposure prophylaxis for HIV infection. N Engl J Med. 2009 Oct 29;361(18):1768-75 PMID: https://pubmed.ncbi.nlm.nih.gov/19864675
- ↑ 8.0 8.1 Whitney JB et al. Rapid seeding of the viral reservoir prior to SIV viraemia in rhesus monkeys. Nature 2014 Aug 7; 512:74 PMID: https://pubmed.ncbi.nlm.nih.gov/25042999
- ↑ Kuhar DT, Henderson DK, Struble KA 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. Erratum in: Infect Control Hosp Epidemiol. 2013 Nov;34(11):1238. Dosage error in article text. PMID: https://pubmed.ncbi.nlm.nih.gov/23917901
- ↑ 10.0 10.1 Centers for Disease Control and Prevention (CDC) Updated guidelines for antiretroviral postexposure prophylaxis after sexual, injection drug use, or other nonoccupational exposure to HIV - United States, 2016. https://stacks.cdc.gov/view/cdc/38856
Announcement. Updated Guidelines for Antiretroviral Postexposure Prophylaxis after Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV -United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65:458 http://www.cdc.gov/mmwr/volumes/65/wr/mm6517a5.htm - ↑ Centers for Disease Control and Prevention. HIV among women U.S. Public Health Service, U.S. Department of Health and Human Services; Nov 17, 2017. https://www.cdc.gov/hiv/group/gender/women/index.html
- ↑ 12.0 12.1 12.2 Tanner MR et al. Antiretroviral postexposure prophylaxis after sexual, injection drug use, or other nonoccupational exposure to HIV - CDC recommendations, United States, 2025. MMWR Recomm Rep 2025 May 8; 74:1. PMID: https://pubmed.ncbi.nlm.nih.gov/40331832 PMCID: PMC12064164 https://www.cdc.gov/mmwr/volumes/74/rr/rr7401a1.htm
- ↑ 13.0 13.1 Kofman AD, Henderson DK, Struble KA et al. 2025 US Public Health Service Guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for post-exposure prophylaxis in healthcare settings. Infect Control Hosp Epidemiol 2025 Sep 15; [e-pub]. PMID: https://pubmed.ncbi.nlm.nih.gov/23917901 https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/2025-us-public-health-service-guidelines-for-the-management-of-occupational-exposures-to-human-immunodeficiency-virus-and-recommendations-for-postexposure-prophylaxis-in-healthcare-settings/A410E90C8C13C8B9FB417C7F42051D2A