HIV Non-Occupational Post-Exposure Prophylaxis (nPEP) Regimens

Key Principles of nPEP

• The Centers for Disease Control and Prevention (CDC) recommends that nPEP should be initiated as soon as possible after exposure, ideally within 72 hours 1, 2
• The recommended duration of nPEP is 28 days 1, 3
• nPEP is recommended when there is substantial risk for HIV transmission and the source is known to have HIV without viral suppression or unknown viral suppression status 1
• A case-by-case determination is needed when exposure presents substantial risk but the source's HIV status is unknown 1, 2

Preferred Regimens for Adults and Adolescents

• The CDC recommends bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) as a preferred regimen for HIV nPEP in adults and adolescents without contraindications 4, 1, 2
• The CDC also recommends dolutegravir (DTG) plus tenofovir alafenamide (TAF) or tenofovir disoproxil fumarate (TDF) plus emtricitabine (FTC) or lamivudine (3TC) as a preferred regimen 4, 1, 2

Regimen Selection Considerations

• For patients with impaired renal function, the CDC prefers tenofovir alafenamide (TAF) over tenofovir disoproxil fumarate (TDF) 3
• The CDC recommends assessing for potential interactions with concurrent medications 3, 2
• The CDC suggests considering different regimens if the patient has a history of antiretroviral exposure 3, 2

Laboratory Testing and Monitoring

• The CDC recommends rapid or laboratory-based antigen/antibody combination HIV testing at the initial visit 1, 2
• For persons with recent long-acting injectable PrEP exposure, the CDC recommends adding an HIV nucleic acid test (NAT) 1, 2
• The CDC recommends interim testing with HIV Ag/Ab test plus HIV NAT at 4-6 weeks post-exposure 1, 2
• The CDC recommends final testing with laboratory-based HIV Ag/Ab combination immunoassay and HIV NAT at 12 weeks post-exposure 1, 2

Follow-up and Transition to PrEP

• The CDC recommends evaluating exposed persons taking nPEP within 72 hours after exposure 5
• The CDC suggests monitoring for drug toxicity for at least 2 weeks 5
• The CDC recommends considering transition to PrEP after completing nPEP for persons with ongoing HIV exposure risk 1, 2
• The CDC recommends performing HIV testing at completion of nPEP before transitioning to PrEP 1, 2

Post-Exposure Prophylaxis with Kositaf

Introduction to PEP Regimens

• The Centers for Disease Control and Prevention (CDC) recommends that PEP requires three antiretroviral drugs, not just two nucleoside reverse transcriptase inhibitors (NRTIs) alone, for adequate protection against HIV transmission 6, 7
• Kositaf (tenofovir/emtricitabine) is effective as part of a complete PEP regimen, but it is not sufficient as monotherapy—it must be combined with an integrase strand transfer inhibitor (INSTI) such as dolutegravir or bictegravir to provide adequate protection against HIV transmission 6, 7

Preferred PEP Regimens

• The CDC's 2025 guidelines recommend the following preferred regimens for adults and adolescents ≥12 years:
• Kositaf would provide the NRTI backbone in the multi-tablet regimen, but dolutegravir is essential 6

Important Considerations for PEP

• Never prescribe tenofovir/emtricitabine alone for PEP—this provides inadequate protection 6, 7