Updated Occupational PEP Guidelines
October 7, 2013
Updated guidelines for management of occupational exposures to HIV were published by the U.S. Public Health Service in September. Among many important recommendations, the new guidelines:
- Eliminate assessment of exposure severity as a means of determining the number of PEP drugs
- Recommend PEP regimens consisting of at least 3 ARVs for all exposed persons
- Recommend newer ARVs as "preferred" and "alternative" regimens for occupational PEP
- Raltegravir + tenofovir DF/emtricitabine (Truvada) is the "preferred" HIV PEP regimen
- Strongly emphasize the importance of ARV tolerability and convenience (eg, once-daily dosing, few pills) to enhance adherence
- Strongly emphasize the importance of monitoring for adverse effects and otherwise supporting exposed persons to complete 28 days of PEP
- Discuss the use of 4th-generation HIV Ag/Ab assays for follow-up testing: if these are used, testing can be concluded 4 months after exposure (as opposed to 6 months with other HIV antibody assays)
- Recommend expert consultation for all HIV exposures
New guidelines for management of nonoccupational exposures are under consideration.
- Kuhar DT, Henderson DK, Struble KA, et al; U.S. Public Health Service Working Group. Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis. Infect Control Hosp Epidemiol. 2013 Sep;34(9):875-92.
Susa Coffey is medical editor of the NCRC. She is a Professor of Medicine at UCSF in the Division of HIV, Infectious Diseases and Global Medicine and a longtime clinician and educator in the HIV at San Francisco General Hospital clinic (“Ward 86”). She also is medical editor of HIV InSite.