|Home : About Us : Contact Us : Search : Site Map|
Management of Non-Occupational Exposure to HIV
For PEP - Sexual Assault (Clinical Protocols)
The CDC released guidelines 1/21/2005 that recommend providing antiretroviral medication following non-occupational exposure to HIV. The preferred regimens recommended for non-occupational post-exposure prophylaxis (nPEP) are identical to those recommended by the Department of Human Health Services for initial therapy in HIV-infected patients:
1. lopinavir/ritonavir + zidovudine + [lamivudine or emtricitibine]
2. efavirenz + [lamivudine or emtricitibine] + [zidovudine or tenofovir].
The CDC document can be found at:
Studies that show PEP is feasible following unsafe sex or needle sharing , but there is no published proof of efficacy of PEP in this setting. Therefore, one must extrapolate from the experience with PEP in occupational exposures and vertical transmission to support the use of PEP for non-occupational exposures. There are a number of differences that distinguish the uses of ARVs for these purposes and the proposed use in non-occupational exposures. Often, the time to presentation in non-occupational exposures is significantly longer than in occupational exposures. Secondly, non-occupational exposures may involve multiple exposures over time rather than one discrete exposure. One frequently cited concern is that providing PEP for non-occupational exposures may promote unsafe behaviors. However, this has not been shown to be true when studied.2
In instances when the source patient is HIV-positive, the risk of acquiring HIV from a single intravenous needle exposure is estimated at 0.67%. The risk of HIV acquisition per episode of receptive anal intercourse is estimated at 0.5% and the estimated risk per episode of insertive anal intercourse is 0.065%. The risk of HIV acquisition per episode of receptive vaginal intercourse is estimated at 0.1% and the estimated risk per episode of insertive vaginal intercourse is 0.05%. As a point of comparison, the risk of HIV following a percutaneous needle stick is 0.3%. In other studies, it has been shown that HIV is transmitted more efficiently sexually when the source has a high viral load.3
Primate studies demonstrate that the animals are viremic by day 5 after intravenous injection with SIV suggesting that PEP should be administered within a few days post-exposure to prevent infection. However, similar studies in humans have obviously not been performed, and it is not known how long after exposure that initiation of PEP would no longer be effective. The CDC guidelines do not recommend providing nPEP if care is sought >72 hours following exposure. The CDC does not recommend nPEP if the exposed patient continues to engage in high-risk behavior, because nPEP would reduce only slightly the patient’s long term probability of acquiring HIV. In these patients, risk reduction counseling is a more effective use of resources than nPEP.
If the HIV status of the source patient is unknown the CDC recommends making decisions regarding nPEP in a case-by-case fashion based on the probability of the source patient having HIV.
lopinavir/RTV (Kaletra) - 2 tablets (400mg/100mg) po twice daily
*Adobe Acrobat Reader is required for viewing or printing PDFs. Acrobat Reader is available free of charge from the Adobe website at http://www.adobe.com/prodindex/acrobat/readstep.html
|FOR PATIENTS : FOR PROVIDERS : PHARMACY : CALENDAR : RESOURCES
About Us : Contact Us : Search : Site Map : Harborview Medical Center : UW Medical Center
| Copyright © 2005 University of Washington. All rights reserved.
Notice of Privacy Practices : Copyright and Disclaimer : Credits and Acknowledgements