Question | Discussion | References | CME Credit

Updated February 6, 2006

Case 5: Nonoccupational Exposure to HIV

Author: Christopher Behrens, MD

A 34-year-old HIV-negative male comes to the clinic for evaluation of possible exposure to HIV. At approximately 11:00 pm on the previous evening he was having receptive anal intercourse with his HIV-infected partner when he noticed the condom they were using had broken. He observed the break in the condom after his HIV-infected partner had ejaculated. The HIV-infected individual had started on his first antiretroviral regimen 6 months earlier, which consisted of zidovudine plus lamivudine (Combivir) plus efavirenz (Sustiva); approximately 8 weeks prior to this event, his HIV RNA level was less than 50 copies/ml and his CD4 count was 458 cells/mm3.

Which of the following statements is TRUE regarding antiviral postexposure prophylaxis (PEP) for the HIV-negative individual’s sexual exposure to HIV?

A Antiviral PEP should not be recommended in this case because the source patient recently had an HIV RNA level less than 50 copies/ml.
B Nevirapine (Viramune) should not be used as part of an antiviral PEP regimen after sexual exposure to HIV.
C The 2005 DHHS guidelines for antiviral PEP after sexual exposure to HIV recommend less aggressive antiretroviral regimens than those used for occupational PEP exposure, because all sexual exposures carry a markedly lower risk of HIV transmission than do percutaneous exposures to HIV.
D Studies have shown that offering PEP in this setting will lead to an increase in unsafe sexual behavior.