What are the preferred antiretroviral drugs for postexposure prophylaxis (PEP) after a nonoccupational HIV infection 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

Answer

The preferred regimens are as follows:

Table 4. Preferred Antiretroviral Agents for Nonoccupational Exposures  (Open Table in a new window)

Population

NRTI backbone

3rd agent

Adults and adolescents > 13 years of age with estimated creatinine clearance > 60 mL/min

Tenofovir DF/emtricitabine fixed dose combination 300/200 mg po daily

Raltegravir 400 mg po BID

OR

Dolutegravir 50 mg po daily

Pregnant women, women of childbearing age

Tenofovir DF/emtricitabine fixed dose combination 300/200 mg po daily

Raltegravir 400 mg po BID

Adults and adolescents > 13 years of age with estimated creatinine clearance < 60 mL/min

Zidovudine/lamivudine po BID; dose adjusted based on renal function

Raltegravir 400 mg po BID

OR

Dolutegravir 50 mg po daily

Two additional considerations should be made for those requiring post-exposure prophylaxis. First, abacavir should never be used for PEP due to the necessity of HLA-B5701 testing used to detect hypersensitivity risk prior to administration. Second, as noted previously, recent data have identified a possible link between neural tube defects and dolutegravir use during conception through the first trimester of pregnancy. The use of dolutegravir should be avoided in women who are early in their pregnancy or not pregnant but at childbearing age. [115, 116]


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