Current perspectives in HIV post-exposure prophylaxis

Figures & data

Table 1 Risk of HIV transmission per exposure

Type of exposure	Estimated median (range) risk of HIV transmission per exposure
Receptive anal intercourse	1.11% (0.042%–3.0%)
Insertive anal intercourse	0.06% (0.06%–0.065%)
Receptive vaginal intercourse	0.1% (0.004%–0.32%)
Insertive vaginal intercourse	0.082% (0.011%–0.38%)
Receptive oral sex (fellatio)	0.02% (0%–0.04%)
Insertive oral sex (receiving fellatio)	0%
Blood transfusion (one unit)	(90%–100%)
Needlestick injury	0.3% (95% CI: 0.2%–0.5%)
Sharing injecting equipment	0.67%
Mucous membrane exposure	0.63% (95% CI: 0.018%–3.47%)

Note: Data are from BASHH Guidelines for PEP.⁶⁴

Abbreviations: BASHH, British Association for Sexual Health and HIV; CI, confidence interval; HIV, human immunodeficiency virus; PEP, post-exposure prophylaxis.

Table 2 Recommended combinations for PEP according to the BASHH guidelines 2011

Recommended combination	Truvada^® (TDF plus FTC) one tablet once dailya and Kaletra^®b,c (ritonavir and lopinavir) two tablets twice daily or four tablets once daily for 28 days
Alternative nucleoside analogs	Stavudine 30 or 40 mg twice daily (according to weight) or Zidovudine 250 mg twice dailyd plus Emtricitabine 200 mg once daily or Lamivudine 300 mg once dailyd
Alternative protease inhibitors	Atazanavir 300 mg once daily plus Ritonavir 100 mg once daily or Darunavir 800 mg once daily plus Ritonavir 100 mg once daily
Alternative to protease inhibitors, eg, in cases with significant drug–drug interactions	Stavudine 30 or 40 mg twice daily (according to weight) or Zidovudine 250 mg twice daily or Raltegravir 400 mg twice daily

Notes:

a Truvada^® is the preferred agent due to pharmacokinetic considerations, tolerability and the evidence base of efficacy based on animal models for the components, ie, TDF and FTC;

b Alternative protease inhibitors;

c Alternative to protease inhibitors;

d available as Combivir^® (GlaxoSmithKline plc, London, UK), one tablet twice daily. Kaletra^®, Abbott Laboratories, Abbott Park, IL, USA; Truvada^®, Gilead Sciences, Foster City, CA, USA. Data are from BASHH PEP guidelines.⁶⁴

Abbreviations: BASHH, British Association for Sexual Health and HIV; FTC, emtricitabine; PEP, post-exposure prophylaxis; TDF, tenofovir disoproxil fumarate.

Table 3 UK PEP monitoring recommendations

	Baseline	Days 3–28	Day 42
FBC (if appropriate)	√	√	–
Renal profile	√	√	–
Liver function	√	√	–
Glucose	√	√	–
Lipids	√	√	–
Urine dipstick/uPCR	√	√	–
PT	√	±	–
Hepatitis B	√	–	√
Syphilis	√	–	√

Note: Data are from BASHH PEP guidelines.⁶⁴

Abbreviations: FBC, full blood count; PEP, post-exposure prophylaxis; PT, prothrombin time; uPCR, urine protein/creatinine; √, recommended; –, not recommended; ±, is indicated.

Table 4 Comparison of Regional Guidelines for nonoccupational PEP

Time to initiation (hours)	Source HIV status
	HIV-positive: viral load detec table				HIV-positive: viral load undetec table				Unknown high prevalence group/area				Unknown low prevalence group/area
	BASHH	CDC	ASHM	EACS	UK-BASHH	CDC	ASHM	EACS	UK-BASHH	CDC	ASHM	EACS	UK-BASHH	CDC	ASHM	EACS
	<72			<48	<72			<48	<72			<48	<72			<48
Receptive anal sex	R	R	Ra	R	R	R	Rb	R	R	C	Rb	R	NR	C	NR	NR
Insertive anal sex	R	R	Ra	R	NR	R	Rc	R	C	C	Rc	R	NR	C	Rc	NR
Receptive or insertive vaginal sex	R	R	Ra	R	NR	R	NR	R	C	C	Cc	R	NR	C	NR	NR
Fellatio with ejaculation	C	–	NR	R	NR	–	NR	R	NR	–	NR	NR	NR	–	NR	NR
Fellatio without ejaculation	NR	–	NR	NR	NR	–	NR	NR	NR	–	NR	NR	NR	–	NR	NR
Sharing of injecting equipment	R	–	Ra	R	NR	–	Rb	R	C	NR	Rb	NR	NR	–	NR	NR

Notes: Data are a summary of international guidelines.^64,81,84,85 – indicates no specific recommendation.

a Three antiretrovirals;

b two antiretrovirals;

c two antiretrovirals if uncircumcised, consider two drugs if circumcised.

Abbreviations: ASHM, Australian Society of HIV Medicine; BASHH, British Association of Sexual Health and HIV; C, consider; CDC, Center for Disease Control; EACS, European AIDS Clinical Society; HIV, human immunodeficiency virus; NR, not recommended; PEP, post-exposure prophylaxis; R, recommended.

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