Case 5: Nonoccupational Exposure to HIV

Question | Discussion | References | CME Credit

Updated February 6, 2006

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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?

	Antiviral PEP should not be recommended in this case because the source patient recently had an HIV RNA level less than 50 copies/ml.
	Nevirapine (Viramune) should not be used as part of an antiviral PEP regimen after sexual exposure to HIV.
	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.
	Studies have shown that offering PEP in this setting will lead to an increase in unsafe sexual behavior.