Post-exposure HIV prophylaxis

Post-exposure prophylaxis (PEP) reduces the probability of HIV transmission by 80% when taken within 72 hours following exposure, and for a full 28-day course as prescribed.[31]Cardo DM, Culver DH, Ciesielski CA, et al. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. N Engl J Med. 1997 Nov 20;337(21):1485-90. https://www.nejm.org/doi/full/10.1056/NEJM199711203372101#t=article http://www.ncbi.nlm.nih.gov/pubmed/9366579?tool=bestpractice.com [27]Otten RA, Smith DK, Adams DR, et al. Efficacy of postexposure prophylaxis after intravaginal exposure of pig-tailed macaques to a human-derived retrovirus (human immunodeficiency virus type 2). J Virol. 2000 Oct;74(20):9771-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC112413/?tool=pubmed http://www.ncbi.nlm.nih.gov/pubmed/11000253?tool=bestpractice.com [28]Tsai CC, Emau P, Follis KE, et al. Effectiveness of postinoculation (R)-9-(2-phosphonylmethoxypropyl) adenine treatment for prevention of persistent simian immunodeficiency virus SIVmne infection depends critically on timing of initiation and duration of treatment. J Virol. 1998 May;72(5):4265-73. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC109656/?tool=pubmed http://www.ncbi.nlm.nih.gov/pubmed/9557716?tool=bestpractice.com In a study of PEP for 100 patients, >90% of which were men who had sex with men (MSM), most exposed by unprotected anal intercourse, there were no HIV infections over the course of the study.[59]Mayer KH, Mimiaga MJ, Gelman M, et al. Raltegravir, tenofovir DF, and emtricitabine for postexposure prophylaxis to prevent the sexual transmission of HIV: safety, tolerability, and adherence. J Acquir Immune Defic Syndr. 2012 Apr 1;59(4):354-9. http://www.ncbi.nlm.nih.gov/pubmed/22267017?tool=bestpractice.com When PEP is unsuccessful, patients should be referred to their local HIV clinic for further investigation and management of their HIV.