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HIV postexposure prophylaxis guidelines revised

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Monitor carefully for side effects

Exposed health care workers and those managing their exposures will now have more PEP options to consider. This offers the benefit of being able to individualize therapy to the individual; however, for providers with less experience in managing HIV exposures, having these options may be more confusing or intimidating. For that reason, expert resources like the HIV PEPline (888-448-4911) will be increasingly important.

These regimens will be more expensive. There aren’t any data to suggest that these three-drug regimens will be more effective in PEP. Here’s why the guideline authors said they made the change:


Dr. C. Bradley Hare

"The recommendation for consistent use of three-drug HIV PEP regimens reflects (1) studies demonstrating superior effectiveness of three drugs in reducing viral burden in HIV-infected persons compared with two agents; (2) concerns about source patient drug resistance to agents commonly used for PEP; (3) the safety and tolerability of new HIV drugs, and (4) the potential for improved PEP regimen adherence due to newer medications that are likely to have fewer side effects. Clinicians facing challenges such as antiretroviral medication availability, potential adherence and toxicity issues, and others associated with a three-drug PEP regimen might still consider a two-drug PEP regimen in consultation with an expert."

Any time you use more drugs, there is an opportunity for side effects. While the medications recommended here are generally safe and well tolerated, careful monitoring for side effects will be important for individuals receiving PEP.

In addition their improved tolerability, I think the other rationale for recommending these exact regimens is based on these regimens being less likely to have resistance.

Dr. C. Bradley Hare is medical director of the HIV/AIDS Clinic at San Francisco General Hospital. He has been a consultant or speaker for the following companies that make HIV medications: Gilead, Bristol-Myers Squibb, Janssen Pharmaceuticals, Merck, and AbbVie Pharmaceuticals.


 

FROM INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY

"With the simplification at this point, they’re throwing away those old tables that required clinicians to assess risk" and decreased the likelihood that PEP would be administered appropriately and completed, he said.

Separate guidelines have been published previously for management of nonoccupational HIV exposure (sexual, pediatric, or perinatal exposures).

Dr. Kuhar reported having no financial disclosures. Some of his coauthors reported financial associations with Bristol-Myers Squibb, Janssen, and other companies. Dr. Goldschmidt reported having no financial disclosures.

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