What are the DHHS guidelines for postexposure prophylaxis (PEP) antiretroviral therapy of HIV infection after an occupational exposure?

Updated: Apr 18, 2019
  • Author: R Chris Rathbun, PharmD, BCPS (AQ-ID), AAHIVP; Chief Editor: John Bartlett, MD  more...
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Answer

PEP is recommended after a healthcare provider is exposed infectious materials from a source person who has or has reasonable suspicion of having HIV infection based on the definitions below:

  • Healthcare provider - all paid and unpaid persons working in healthcare settings
  • Exposure - percutaneous injury or contact of mucous membranes or nonintact skin without barrier protection
  • Infectious materials - blood, tissue, semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, amniotic fluid, or visibly bloody body fluids

Treatment should be initiated as soon as possible (within hours) after an exposure has occurred. Efficacy of PEP initiated 72 hours after exposure has not been well described but can still be considered, even a week after exposure, in patients at high risk for transmission.

The preferred regimen is tenofovir DF/emtricitabine fixed dose combination (300/200 mg po daily) with raltegravir (400 mg po BID) for 28 days. Alternative options are available in the U.S. Public Health guidelines for occupational HIV exposure. [115]


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