CDC releases updated recommendations on HIV postexposure prophylaxis
Among other guidance, the agency said nonoccupational postexposure prophylaxis is recommended within 72 hours of an exposure that presents a substantial risk for HIV transmission when the source has HIV without known sustained viral suppression.
A person who has a nonoccupational exposure to nonintact skin or mucous membranes that presents substantial risk for HIV transmission should receive nonoccupational postexposure prophylaxis (nPEP) if the source has HIV without known sustained viral suppression, according to new recommendations from the CDC.
nPEP is not recommended if the exposure presents no substantial risk for HIV transmission and should be stopped if at any point the source is found to not have HIV, the CDC said. A rapid or point-of-care or laboratory-based antigen/antibody combination HIV test is recommended before starting nPEP, according to the guidance, and health care professionals should ensure that the first dose of nPEP is provided as soon as possible, ideally within 24 hours, but no later than 72 hours after exposure. The initial nPEP dose should not be delayed because results of any laboratory tests are pending, the guidance said. The CDC recommends a 28-day course of nPEP.
The preferred nPEP regimens for most adults and adolescents are now bictegravir/emtricitabine/tenofovir alafenamide or dolutegravir plus tenofovir alafenamide or tenofovir disoproxil fumarate plus emtricitabine or lamivudine, the CDC said. Regimens should be selected on an individual basis according to comorbid conditions, pregnancy, potential for drug interactions, and previous exposure to antiretroviral regimens, among other factors.
Recommended follow-up for those prescribed nPEP includes a clinician visit at 24 hours (remote or in person) and clinical follow-up four to six weeks and 12 weeks after exposure for laboratory testing. Patients taking nPEP should be informed that pre-exposure prophylaxis for HIV (PrEP) can reduce their risk for HIV infection if they will have repeated or continuing exposure to HIV after the end of the nPEP course, the CDC said. The agency notes that health care professionals should offer PrEP options to patients with ongoing indications and create an “nPEP-to-PrEP” transition plan when necessary.
The CDC's guidelines replace the agency's 2016 recommendations on this topic and also include additional clinical guidance, including implementation considerations when starting nPEP, counseling and education, and considerations for specific populations. They were released May 6 by MMWR.
An Ideas and Opinions piece in Annals of Internal Medicine, also published May 6, offered an infectious diseases physician's perspective on the primary points of the recommendations, including indications and timing of nPEP, recommended antiretroviral regimens, laboratory testing, and implementation, education, and support.