When the exposure source's HIV status is unknown and testing of the source is possible, use of a rapid HIV test kit may facilitate decision making at the point of care. Postexposure prophylaxis (PEP) with antiretroviral medications against human immunodeficiency virus (HIV) may be indicated in situations that family physicians often encounter. Information on HIV PEP Medications A nonpregnant woman of childbearing potential who is prescribed dolutegravir should be counseled to use an effective birth control method until she completes the PEP regimen. Estimate of the annual number of percutaneous injuries among hospital-based healthcare workers in the United States, 1997-1998. Send thanks to the doctor . Young T, Arens FJ, Kennedy GE, Laurie JW, Rutherford GW. Do not administer with polyvalent cations.Insomnia, nausea, fatigue, headache, and severe skin and hypersensitivity reactions have been reported.EFV: 600 mg daily; available as 50- and 200-mg capsules and 600-mg tabletsAlso available as component of fixed-dose combination Atripla, dosed daily (200 mg of FTC + 300 mg of TDF + 600 mg of EFV)Neuropsychiatric side effects (eg, dizziness, somnolence, insomnia, abnormal dreaming) common; severe psychiatric symptoms possible (dosing before bedtime might minimize these side effects); use with caution in shift workersDo not use during pregnancy; teratogen in nonhuman primatesPotential for serious or life-threatening drug interactions that may affect dosingMay cause false-positive results with some cannabinoid and benzodiazepine screening assays Take on an empty stomachAvailable as a component of fixed-dose combination Stribild, dosed daily (150 mg of EVG + 150 mg of cobicistat + 300 mg of TDF + 200 mg of FTC)Nephrotoxicity; should not be administered to individuals with acute or chronic kidney injury or those with eGFR < 70Cobicistat is a pharmacokinetic enhancer to increase EVG exposures and has no antiviral activity but is a potent CYP3A inhibitorPotential for serious or life-threatening drug interactionsAlso available as component of fixed-dose combination Atripla, dosed daily (200 mg of FTC + 300 mg of TDF + 600 mg of EFV)Complera, dosed daily (25 mg of RPV + 300 mg of TDF + 200 mg of FTC)Stribild, dosed daily (150 mg of EVG + 150 mg of cobicistat + 300 mg of TDF + 200 mg of FTC)Truvada, dosed daily (200 mg of FTC + 300 mg of TDF)If the PEP recipient has chronic hepatitis B, withdrawal of this drug may cause an acute hepatitis exacerbationT20: 90 mg (1 mL) twice daily by subcutaneous injection; available as single-dose vial, reconstituted to 90 mg/mLLocal injection-site reactions occur in almost 100% of patientsNever studied among antiretroviral-naive or HIV-negative patientsFalse-positive EIA HIV antibody tests might result from formation of anti-T20 antibodies that crossreact with anti-gp41 antibodies200 mg twice daily; available as 100- and 200-mg tabletsWell tolerated and has not had the same frequency of CNS side effects reported as EFVRash (including SJS) and hypersensitivity (sometimes with organ dysfunction, including hepatic failure)Potential for serious or life-threatening drug interactions that may affect dosingFOSAPV: 1,400 mg daily + RTV: 100 mg once daily (preferred dosing for PEP)FOSAPV: 1,400 mg twice daily without RTV (alternative dosing)Diarrhea, nausea, vomiting, headache, rash (FOSAPV has sulfonamide moiety)Potential for serious or life-threatening drug interactions that may affect dosingAlso available as component of fixed-dose combination generic lamivudine/zidovudine, dosed twice daily (150 mg of 3TC + 300 mg of AZT)Combivir, dosed twice daily (150 mg of 3TC + 300 mg of AZT)Epzicom, dosed daily (300 mg of 3TC + 600 mg of ABC)Trizivir, dosed twice daily (150 mg of 3TC + 300 mg of ABC + 300 mg of AZT)If the PEP recipient has chronic hepatitis B, withdrawal of this drug may cause an acute hepatitis exacerbationKaletra: 400/100 mg = 2 tablets twice daily (preferred dosing for PEP)Kaletra: 800/200 mg = 4 tablets once daily (alternative dosing)GI intolerance, nausea, vomiting, diarrhea are commonPR and QT interval prolongation have been reported; use with caution in patients at risk of cardiac conduction abnormalities or receiving other drugs with similar effectPotential for serious or life-threatening drug interactions that may affect dosingMVC: 300 mg twice daily (if on concomitant CYP3A inducers, dose may need adjustment by expert consultant); available as 150- and 300-mg tabletsAbdominal pain, cough, dizziness, musculoskeletal symptoms, pyrexia, rash, orthostatic hypotensionHepatotoxicity that may present with an allergic reaction, including rashRequires HIV tropism testing of source virus before treatment to ensure CCR5-tropic virus and efficacy, which may not be available or practical prior to initiating PEPPotential for serious or life-threatening drug interactions that may affect dosingDose adjustments for MVC required when given with potent CYP3A inhibitors or inducersInsomnia, nausea, fatigue, headache, and severe skin and hypersensitivity reactions have been reportedAlso available as component of fixed-dose combination Complera, dosed daily (25 mg of RPV + 300 mg of TDF + 300 mg of FTC)Well tolerated and fewer rashes and discontinuations for CNS adverse effects compared with EFVDepression, insomnia, rash, hypersensitivity, headachePotential for serious or life-threatening drug interactions that may affect dosingCaution when coadministered with H2 antagonists and antacidsCoadministration with proton pump inhibitors is contraindicatedUse RPV with caution when coadministered with a drug having a known risk of torsades de pointesSQV: 1,000 mg + RTV: 100 mg twice daily (preferred dosing for PEP); available as 500 mg tabletSQV/r is not recommended for patients with any of the following: (1) congenital or acquired QT prolongation, (2) pretreatment ECG 1450 msec, (3) receiving concomitant therapy with other drugs that prolong QT interval, (4) complete AV block without implanted pacemakers, and (5) risk of complete AV blockPR and QT interval prolongations, torsades de pointes has been reportedPotential for serious or life-threatening drug interactions that may affect dosingHepatotoxicity, neurologic symptoms (eg, peripheral neuropathy), pancreatitisAlso available as component of fixed-dose combination Atripla, dosed daily (200 mg of FTC + 300 mg of TDF + 600 mg of EFV)Complera, dosed daily (25 mg of RPV + 300 mg of TDF + 200 mg of FTC)Stribild, dosed daily (150 mg of EVG + 150 mg of cobicistat + 300 mg of TDF + 200 mg of FTC)Truvada, dosed daily (200 mg of FTC + 300 mg of TDF)Nephrotoxicity; should not be administered to individuals with acute or chronic kidney injury or those with eGFR < 60If the PEP recipient has chronic hepatitis B, withdrawal of this drug may cause an acute hepatitis exacerbationAZT: 300 mg twice daily; available as 100-mg capsule or 300- mg tabletAlso available as component of fixed-dose combination generic lamivudine/zidovudine, dosed twice daily (150 mg of 3TC + 300 mg of AZT)Combivir, dosed twice daily (150 mg of 3TC + 300 mg of AZT)Trizivir, dosed twice daily (150 mg of 3TC + 300 mg of ABC + 300 mg of AZT) TaSide effects (especially nausea, vomiting, headache, insomnia, and fatigue) common and might result in low adherenceNOTE.
Health care volunteers working abroad, particularly in areas of high HIV prevalence or where preferred PEP regimens may not be readily available, often choose to travel with personal supplies of PEP. Hamory BH. (Optional) New York State Department of Health AIDS Institute, Clinical Guidelines Development Program. Available at Kuhar DT, Henderson DK, Struble KA, Heneine W, Thomas V, Cheever LW, et al. Smith DK,
Havens PL; Bassett IV, Read all of this leaflet carefully before you start taking this medicine because it contains important information for you. 2002
0 comment. To see the full article, log in or purchase access.HIV = human immunodeficiency virus; PEP = postexposure prophylaxisA = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. I rushed back to hospital and told them. American Academy of Pediatrics Committee on Pediatric AIDS. When PEP is given, timing and duration are important, with data showing PEP to be most effective when initiated within 72 hours of exposure and continued for four weeks.
Updated U.S. Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for postexposure prophylaxisAdapted from Smith DK, et al. Family physicians often encounter situations in which postexposure prophylaxis (PEP) with antiretroviral medications against human immunodeficiency virus (HIV) may be indicated. Antiretroviral post-exposure prophylaxis (PEP) for occupational HIV exposure.
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