Post-Exposure Prophylaxis After Needle Stick Injury from HIV Patient
Introduction to PEP
- The CDC recommends initiating PEP immediately after a needle stick injury from an HIV-positive patient, even when the source patient has an undetectable viral load, because occupational exposures warrant prophylaxis regardless of the source's viral suppression status 1, 2, 3
Immediate Action Required
- PEP should be started as soon as possible, ideally within 1-2 hours, but no later than 72 hours after the needle stick, as efficacy decreases significantly with delayed initiation beyond 24 hours 1, 2, 3
- The first dose of PEP should not be delayed while awaiting HIV testing of either the exposed healthcare worker or confirmation of the source patient's viral load status 3
Preferred PEP Regimen
- The CDC recommends a preferred single-tablet regimen: Bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) - one tablet once daily for 28 days 1, 2, 3
- An alternative multi-tablet regimen is Dolutegravir (DTG) 50mg once daily PLUS emtricitabine/tenofovir alafenamide (FTC/TAF) 200mg/25mg once daily for 28 days 1, 2, 3
Critical Timing and Duration
- The full 28-day course of PEP should be completed regardless of subsequent information about the source patient 1, 2, 3
- If the source is later confirmed HIV-negative, PEP can be stopped 3
Baseline and Follow-Up Testing Protocol
- At initial presentation, a rapid or laboratory-based HIV antigen/antibody combination test should be performed before starting PEP 1, 3
- Follow-up HIV testing should be done at 4-6 weeks and 12 weeks after exposure 1, 3
Special Considerations
- For patients with impaired renal function, tenofovir alafenamide (TAF) should be used instead of tenofovir disoproxil fumarate (TDF) 3
- Baseline renal function should be assessed before initiating any tenofovir-based regimen 3