Post-Exposure Prophylaxis Regimens and Management

Basic PEP Regimen Components

The Centers for Disease Control and Prevention recommends a 28-day course of a three-drug combination consisting of tenofovir disoproxil fumarate (TDF) plus lamivudine (3TC) or emtricitabine (FTC) as the backbone, with lopinavir/ritonavir (LPV/r) or atazanavir/ritonavir (ATV/r) as the preferred third drug for HIV post-exposure prophylaxis in adults and adolescents 1
For children ≤10 years, the preferred backbone regimen is ZDV (zidovudine) + 3TC, with LPV/r as the recommended third drug 1

The Centers for Disease Control and Prevention suggests that PEP should be initiated as soon as possible after exposure, ideally within 72 hours, and the full 28-day course of PEP should be prescribed at the initial assessment 1

For pregnant healthcare workers, the Centers for Disease Control and Prevention considers ZDV + 3TC (Combivir) a safe regimen 2, 3
For individuals with renal impairment, the American College of Physicians notes that dose adjustments may not be necessary, but TAF (tenofovir alafenamide) + FTC may be considered for individuals with creatinine clearance between 30-60 ml/min or with known bone density issues 4

The Centers for Disease Control and Prevention recommends evaluating exposed persons taking PEP within 72 hours after exposure, monitoring for drug toxicity for at least 2 weeks, and performing HIV-antibody testing at baseline, 6 weeks, 3 months, and 6 months post-exposure 2, 5
The Centers for Disease Control and Prevention advises exposed persons to use precautions to prevent secondary transmission during the follow-up period and to seek immediate medical evaluation for any acute illness occurring during follow-up 2

The Centers for Disease Control and Prevention notes that side effects are generally manageable with antimotility and antiemetic agents, and serious toxicity is rare when used for PEP 2