Time to Change the PEP Guidelines?

Brian R. Wood, MD; Paul E. Sax, MD


AIDS Clinical Care 

In This Article

Abstract and Introduction


A new study supports the use of tenofovir/FTC plus raltegravir for nonoccupational postexposure prophylaxis.


Despite the introduction of several new HIV drugs in recent years, guidelines on the provision of antiretroviral therapy for nonoccupational postexposure prophylaxis (PEP) have not changed since 2005. Standard of care still involves 28 days of tenofovir/FTC, either alone or with a boosted protease inhibitor (PI; typically lopinavir/ritonavir), depending on the risk associated with the exposure. However, adverse effects, particularly with the PI-based regimen, often lead to early treatment discontinuation.

In the present study, researchers evaluated the safety and effectiveness of an alternative PEP regimen — tenofovir/FTC + twice-daily raltegravir — among 100 adults seen at a health clinic within 72 hours after potential sexual exposure to HIV. All but two of the study participants were male, and most were men who have sex with men. Results were compared with historical data from the same clinic.

Eighty-five study participants were seen at 3 months, and none of them had seroconverted. The adverse effects of the regimen were mild and similar to those previously seen with tenofovir/FTC alone. Fifty-seven percent of participants completed 28 days of the regimen as prescribed, and another 27% completed a modified regimen, which typically involved tenofovir/FTC plus only the first daily dose of raltegravir. These completion rates were comparable to those previously reported for tenofovir/FTC alone and better than those previously reported for AZT/3TC plus a PI.