What are the HIV postexposure prophylaxis (PEP) regimens?

Updated: Jul 08, 2021
  • Author: Derek T Larson, DO; Chief Editor: Michael Stuart Bronze, MD  more...
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Although the exact drug regimens for HIV PEP have changed in recent years, consensus remains that the preferred regimen is a 3-drug regimen given over a 28-day course. [1]  Anyone prescribed PEP should be given the full 28-day course. On occasion, a 30-day supply will be dispensed due to the cost of adjusting manufacterer-supplied bottles, but no added benefits have been shown for continuation of the treatment course beyond 28 days.

The FDA announced in May 2018 that it was investigating correlations between dolutegravir use in early pregnancy and neural tube defects. Although such a correlation had not been shown definitively, guidance was issued at that time that women who were pregnant or of childebearing potential avoid dolutegravir and bictegravir while further evaluation was performed. Studies indicated that the increased rate of neural tube deficits seen in a cohort of HIV-infected individuals in Botswana [34]  was not seen in the United States. [35]  Further, Raltegravir has a well-established safety profile for this use and remains a primary treatment option. [36]  In February of 2021, the Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission recommended the use of dolutegravir as a prefered agent both for women who are pregnant, and those attempting to get pregnant. This was based on the lack of neural tube defect in later cohorts, as well as the known benefits of dolutegrvir which include therapeutic efficacy, tolerance, and ease of administration with once daily dosing. [37]

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