What are the CDC recommendations for postexposure prophylaxis (PEP) for HIV infection?

Updated: Mar 05, 2020
  • Author: Delia M Rivera, MD; Chief Editor: Russell W Steele, MD  more...
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Answer

The CDC has recommended basic and expanded HIV postexposure prophylaxis (PEP) regimens. For details, see the Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis. Also see the Medscape Reference articles Antiretroviral Therapy for HIV Infection and Body Fluid Exposures.

An overview of the CDC recommendations for PEP are as follows:

  • Basic PEP 2-drug regimen - Zidovudine plus lamivudine, zidovudine plus emtricitabine, tenofovir plus lamivudine, or tenofovir plus emtricitabine

  • Alternative basic PEP regimen - Lamivudine plus stavudine, lamivudine plus didanosine, emtricitabine plus stavudine, or emtricitabine plus didanosine

  • Expanded PEP regimen - Basic PEP regimen plus lopinavir-ritonavir

An alternative expanded PEP regimen includes the basic PEP regimen plus one of the following:

  • Atazanavir with or without ritonavir

  • Fosamprenavir with or without ritonavir

  • Indinavir with or without ritonavir

  • Saquinavir with or without ritonavir

  • Nelfinavir

  • Efavirenz

Use of nevirapine for PEP is generally not recommended because of a risk of early onset rash and severe hepatotoxicity.


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