CDC Guidelines for HIV Post-Exposure Prophylaxis

Preferred Regimens

The CDC recommends bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) as a single tablet once daily for 28 days as the preferred HIV post-exposure prophylaxis regimen, initiated within 72 hours of exposure (ideally within 24 hours) 1, 2, 3
Bictegravir 50mg/emtricitabine 200mg/tenofovir alafenamide 25mg (BIC/FTC/TAF) is a single-tablet regimen that simplifies adherence 2
Tenofovir alafenamide (TAF) is preferred over tenofovir disoproxil fumarate (TDF) due to improved renal and bone safety profiles 2
Dolutegravir (DTG) 50mg once daily PLUS emtricitabine/tenofovir alafenamide (FTC/TAF) 200mg/25mg once daily is a multi-tablet regimen for 28 days 1, 2, 3
Can substitute tenofovir disoproxil fumarate (TDF) 300mg for TAF if TAF is unavailable, but TAF is preferred 1, 3
Can substitute lamivudine (3TC) 300mg for emtricitabine if needed 1, 3

Initiate PEP as soon as possible, ideally within 24 hours of exposure 3
Must start within 72 hours maximum—efficacy decreases significantly with delayed initiation 3
Do not delay the first dose while awaiting laboratory results or source patient testing 2, 3
If the source is confirmed HIV-negative during the 28-day course, PEP can be stopped 2

For patients with impaired renal function, use tenofovir alafenamide (TAF) instead of tenofovir disoproxil fumarate (TDF) 1
Assess baseline renal function before initiating any tenofovir-based regimen 2

Rapid or laboratory-based HIV antigen/antibody combination test at initial visit 1, 3
Add HIV nucleic acid test (NAT) if the patient received long-acting injectable PrEP in the past 12 months 1, 3
Assess renal function, current medications, allergies, and medical comorbidities at initial visit 2, 3
Evaluate within 72 hours after starting PEP 1, 3
Monitor for drug toxicity for at least 2 weeks 1, 3
At 4-6 weeks: HIV Ag/Ab test plus HIV NAT 1, 3
At 12 weeks: Laboratory-based HIV Ag/Ab combination immunoassay and HIV NAT 1, 3

Never prescribe only two NRTIs (like tenofovir/emtricitabine alone) for PEP—this provides inadequate protection and requires a third drug (integrase inhibitor) 1
Never use salvage therapy agents (fostemsavir, ibalizumab) for PEP—these are reserved for treatment-experienced patients with documented resistance 2
Never delay initiation beyond 72 hours, as effectiveness drops significantly 3
Assess for potential interactions with concurrent medications before prescribing 1, 3
Consider different regimens if the patient has a history of antiretroviral exposure 1

Consider immediate transition from PEP to PrEP for persons with anticipated repeat or ongoing HIV exposures 1, 3
Perform HIV testing at completion of the 28-day PEP course before transitioning to PrEP 1, 3