HIV post-exposure prophylaxis

Background

Exposure Transmission Risk

Exposure^	Risk
Percutaneous	0.3%
Mucocutaneous	0.09%
Needle-sharing injection drug	0.7%
Receptive anal intercourse	0.5%
Receptive penile-vaginal intercourse	0.1%
Insertive anal intercourse	0.07%
Insertive penile-vaginal intercourse	0.05%
Receptive oral (male) intercourse	0.01%
Insertive oral (male) intercourse	0.005%

^assumes no condom use

Workup

1. Td
2. Hepatitis B PEP for non-vaccinated
   1. Hepatitis B immunoglobulin and/or vaccine
3. Source labs
   1. Rapid HIV, hep pannel, RPR?
4. Exposed labs
   1. Rapid HIV, hep pannel, RPR?
5. Consider HIV PEP
   1. CBC, C7, LFTs, Icon if considering HIV PEP

^Currently no PEP for Hep C

HIV PEP

• ~79% transmission reduction
• Initiate ASAP (goal = 1-2 hours)
• >36 hours: normally deferred, unless particularly high risk
• Common side-effects = constitutional, gastrointestinal

Specific Regimens (CDC)

1. Basic (2-Drug)
   1. Tenofovir-Emtricitabine 300mg/200mg (Truvada): 1 tab PO QD
   2. OR, Zidovudine-Lamivudine 300mg/150mg (Combivir)^: 1 tab PO BID
2. Expanded (3-Drug)
   1. Ritonavir-Lopinavir 50mg/200mg(Kaletra): 2 tabs PO BID
      1. PLUS tenofovir-emtricitabine OR zidovudine-lamivudine

^Prefered in pregnancy

National HIV/AIDS Clinicians' Consultation Center: 888-448-4911

High Risk

Source

1. Symptomatic HIV/AIDS
2. Acute seroconversion
3. High viral load

Exposure

1. Deep injuries
2. Visible blood on device
3. Injuries sustained placing a catheter in a vein/artery

See Also

Occupational Exposure

Source

8/07 DONALDSON