Answer
The Public Health Service (PHS) no longer recommends that the severity of exposure be used to determine the number of drugs to be offered in an HIV PEP regimen. Currently, a regimen that contains 3 (or more) antiretroviral drugs is recommended routinely for all occupational HIV exposures.
Examples of recommended PEP regimens include those that consist of a dual nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) backbone plus an integrase strand transfer inhibitor (INSTI), a ritonavir-boosted protease inhibitor (PI), or a nonnucleoside reverse transcriptase inhibitor (NNRTI). [5]
Preferred regimen
-
Raltegravir (400 mg) is given twice daily; enofovir/emtricitabine (300 mg/200 mg) is given once daily
Alternative regimens
Alternative regimens may combine 1 drug or drug pair from the INSTI, PI, or NNRTI classes with 1 pair of NRTIs listed below.
INSTI, PI, or NNRTI options include the following:
-
Raltegravir
-
Atazanavir plus ritonavir
NRTIs combined with agent(s) selected above include the following:
-
Tenofovir/emtricitabine
-
Tenofovir plus lamivudine
-
Zidovudine plus emtricitabine
Alternative antiretroviral agents for use as PEP only with expert consultation include the following:
The following antiretroviral agents are generally not recommended for use as PEP:
The following antiretroviral agent is contraindicated as PEP:
