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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 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 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 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