Download ILH HIV Post Exposure Prophylaxis

ILH HIV Postexposure Prophylaxis (PEP) Medication Change
Summary Report to Emergency Department Physicians and Residents 10/8/13
Joanne Maffei, MD
Occupational HIV Postexposure Prophylaxis:
New National Guidelines:
Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human
Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis. Infection Control and Hospital
Epidemiology 2013;34(9):875-892
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The first line medications for HIV postexposure prophylaxis (PEP) have changed. Instead of Combivir
[Ziduvodine (AZT) + Lamivudine (3TC)] and Kaletra (Lopinavir/Ritonavir) which we now stock, the
recommended first line agents are:
Truvada (tenofovir 300 mg + emtricitabine 200 mg) 1 PO once daily
Plus
Raltegravir (Isentress) 400 mg PO twice daily
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Another change in the recommendation is that all occupational exposures to HIV should receive 3 (or
more) PEP medications. This is in contrast to the last recommendation that stratified exposures by
severity and the clinician chose “basic” (2 drug PEP which was Combivir) or “expanded” (3 or more
drug PEP which was Combivir + Kaletra).
HIV PEP medication duration is still a 4 week course.
Special Circumstances:
We are still going to need the option of choosing other HIV PEP medications for special circumstances such as:
 resistance in the source patient’s HIV virus to the recommended regimen
 healthcare worker medical issues that may preclude using stock meds
o renal insufficiency – dosing of tenofovir and emtricitabine needs to be adjusted
 Pregnancy in the healthcare worker – Discussed the medication change with Dr. Maupin – plan to
keep the old regimen Combivir and Kaletra for those cases for now
Nonoccupational HIV Postexposure Prophylaxis
Old National Guidelines:
Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other
Nonoccupational Exposure to HIV in the United States Recommendations from the U.S. Department of Health
and Human Services MMWR 2005;54(No. RR-2):1-20. Combivir and Kaletra as preferred protease inhibitor
based regimen
New Guidelines in New York:
HIV Prophylaxis Following Non-Occupational Exposure. New York State Department of Health AIDS
Institute: www.hivguidelines.org Updated July 2013. Truvada and Raltegravir as preferred regimen
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I sent a query to the Infectious Diseases Society of America Emerging Infections Network – received 5
responses from across the nation that stated they were using same medications for both occupational and
nonoccupatonal HIV PEP
Suggest ILH follow New York State Department of Health July 2013 guidelines and use the same
regimen for both occupational and nonoccupational HIV PEP
SANE orders will need to be changed via ED MD – needs help desk ticket to get Pelican orders updated
– I submitted the medication suggestions to SANE nurses
Same special circumstances apply