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HIV Post Exposure Prophylaxis

Medication Regimens Used After An HIV Exposure

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Updated: September 02, 2007

The Centers for Disease Control (CDC) has recommendations for the type of HIV medication regimens that should be used after an incidental HIV exposure such as a needle stick or a broken condom.

What To Do If The Condom Breaks

Needlestick Fact Sheet

Basic Regimen

Retrovir (AZT, Zidovudine, ZDV) 300mg twice daily + Epivir (lamivudine)300mg daily; can be taken as Combivir one tablet twice daily.

  • Advantages
    • AZT is associated with decreased risk of HIV transmission in the CDC case-control study of occupational HIV infection.
    • AZT has been used more than the other drugs for PEP.
    • Serious toxicity is rare when used for Post Exposure Prophylaxis (PEP).
    • Side effects (diarrhea, nausea, vomiting, headache, fatigue) are predictable and manageable.
    • It is a safe regimen for pregnant women.
    • Can be given as a single tablet of Combivir twice daily.

  • Disadvantages
    • Side effects are common and might result in poor adherence.
    • Source patient virus might have resistance to this regimen.
    • Potential for delayed toxicity is unknown.

      Medication Side Effects and Solutions

Alternate Regimens

Epivir (lamivudine, 3TC) 300mg daily + Zerit (stavudine) 40mg twice daily.

Videx EC (didanoosine) 400mg daily + Zerit (stavudine) 40mg twice daily

  • Advantages
    • Likely to be effective against HIV strains from source patients who are taking ZDV and 3TC.

  • Disadvantages
    • Serious toxicity (e.g., neuropathy, pancreatitis, or hepatitis) can occur.
    • Fatal and nonfatal pancreatitis has occurred in HIV-positive, treatment-naive patients. Patients taking Videx EC and Zerit should be carefully assessed and closely monitored for pancreatitis, lactic acidosis, and hepatitis.
    • Side effects are common; anticipate diarrhea and low adherence.
    • Potential for delayed toxicity is unknown.
    • Zerit has been associated with lactic acidosis.

      Your Guide to Lactic Acidosis

Expanded Regimens - Basic regimens plus one of the following.

Crixivan (indinavir) 800mg three times daily

  • Advantages
    • Potent HIV inhibitor

  • Disadvantages
    • Serious toxicity (e.g., kidney stones) can occur; must take 8 glasses of fluid per day.
    • Hyperbilirubinemia common; must avoid this drug during late pregnancy.
    • A three times daily regimen often leads to poor adherence.

Viracept (nelfinavir) 1250mg twice daily

  • Advantages
    • Potent HIV inhibitor.
    • Twice daily dosing improves adherence.

  • Disadvantages
    • Side effects such as diarrhea are quite common.
    • Dosing as 5 tablets twice per day may lead to poor adherence due to large pill burden.

Sustiva (efavirenz) 600mg at bedtime

  • Advantages
    • One dose daily improves adherence.

  • Disadvantages
    • Drug is associated with rash (early onset) that can be severe.
    • Differentiating between early drug-associated rash and acute seroconversion can be difficult and cause extraordinary concern for the exposed person.
    • Nervous system side effects (e.g., dizziness, drowsiness, insomnia, and/or abnormal dreaming) are common. Severe psychiatric symptoms are possible (dosing before bedtime might minimize these side effects).
    • Can not be used during pregnancy.
    • Potential for toxicity is unknown.
    • Often worsens the signs and symptoms of depression.

      Recognizing Acute Seroconversion

Kaletra (lopinavir / ritonavir) three capsules twice daily.

  • Advantages
    • Potent HIV inhibitor
    • Usually well tolerated.

  • Disadvantages
    • Nausea and other GI side effects are common and may result in poor adherence.
    • Pill burden may result in poor adherence.

Keep in mind these selections are just recommendations and may vary somewhat between physicians. It is important to note that if PEP is necessary, a HIV specialist should be consulted and should monitor the patient over the course of treatment.

If you believe you may have been exposed to HIV, contact your physician or be evaluated in the nearest emergency department as soon as possible.

Check out our other articles dealing with HIV exposure.

  1. About.com
  2. Health
  3. AIDS / HIV
  4. Testing & Prevention
  5. HIV Prevention
  6. HIV Exposure - HIV Post Exposure Prophylaxis (PEP) - HIV Post Exposure

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