Post-Exposure Prophylaxis (PEP) for HIV: Detailed Overview
Definition: PEP is a 28-day course of HIV medicines taken to prevent HIV infection after potential exposure. It must be started within 72 hours (3 days) of exposure for the best chance of effectiveness.
When to Start:
- Critical Window: Initiate PEP as soon as possible after exposure, ideally within hours. Even a delay of 72 hours may significantly reduce its effectiveness.
Who Needs PEP?
- Healthcare workers after needlestick injuries, sexual assault victims, or anyone at risk of HIV exposure.
Regimens (as per U.S. guidelines):
- Standard Regimen (for most exposures):
- Truvada (tenofovir disoproxil fumarate/emtricitabine) + Isentress (raltegravir)
- Taken twice daily for 28 days.
- Alternative Regimen (if resistance is suspected):
- Truvada + Reyataz (atazanavir) + Norvir (ritonavir)
- Also taken twice daily for 28 days.
Key Considerations:
- Adherence: Strict daily adherence is crucial. Missing doses reduces effectiveness.
- Side Effects: May include nausea, fatigue, or dizziness. Report severe side effects to a healthcare provider.
- Special Populations: Pregnant/breastfeeding individuals or those exposed to drug-resistant HIV may need tailored regimens. Consult the National Clinicians’ PEPline (888-448-4911) for guidance.
- Follow-Up: Includes HIV testing at baseline, 4-6 weeks, 3 months, and 6 months post-exposure, plus monitoring for side effects.
Wound Care:
- Clean the wound immediately with soap and water or an antiseptic.
Resources:
- PEPline: 24/7 support for complex cases (888-448-4911).
- Websites: HIVinfo.nih.gov and HIV.gov for detailed guidelines.
Warning: PEP is not 100% effective, and it does not replace routine HIV prevention methods like condoms or PrEP (pre-exposure prophylaxis).
