HIV Postexposure Prophylaxis, Non-Occupational 

Updated: Apr 10, 2015
  • Author: Jason F Okulicz, MD, FACP, FIDSA; more...
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HIV Postexposure Prophylaxis, Non-Occupational

The Centers for Disease Control and Prevention (CDC) and other federal government agencies have issued several guidelines and recommendations concerning the prevention, screening, diagnosis, treatment, and management of human immunodeficiency virus (HIV) infection. [1] The CDC’s recommendations for antiretroviral postexposure prophylaxis (PEP) after sexual, injection-drug use, or other nonoccupational HIV exposure in the United States are summarized below. [2, 3]

Updated CDC recommendations for nonoccupational exposures are currently under peer review. CDC guidelines for occupational exposures have been recently updated and are summarized in HIV Postexposure Prophylaxis, Occupational.

A 28-day course of antiretroviral therapy is recommended in persons who have had a nonoccupational exposure that represents a substantial risk for HIV transmission and when the person seeks care within 72 hours of exposure. When indicated, antiretroviral PEP should be initiated promptly for the best chance of success.

Substantial risk for HIV exposure

See the list below:

  • Exposure of vagina, rectum, eye, mouth, mucous membrane, nonintact skin, or percutaneous contact to substantial-risk bodily fluids
  • Bodily fluids with substantial risk include blood, semen, vaginal secretions, rectal secretions, breast milk, or bloody body fluid
  • Bodily fluid from known HIV-infected source

Negligible risk for HIV exposure

See the list below:

  • Exposure of vagina, rectum, eye, mouth, mucous membrane, nonintact skin, or percutaneous contact to negligible-risk bodily fluids
  • Bodily fluids with negligible risk include urine, nasal secretions, saliva, sweat, or tears with no visible blood
  • Regardless of HIV status of source person

Treatment recommendations

Substantial risk for HIV exposure

  • ≤72 hours from exposure and known HIV-positive source: PEP recommended
  • ≤72 hours from exposure and source of unknown HIV status: Case-by-case basis
  • >72 hours from exposure: No PEP recommended

Negligible risk for HIV exposure

  • No PEP recommended

Antiretroviral drug regimens

No evidence indicates that any specific antiretroviral medication or combination of medications is optimal for use as PEP. However, based on the degree of experience with individual agents in the treatment of HIV-infected persons, certain agents and combinations are preferred. Regimens typically consist of 2 nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) in combination with a nonnucleoside reverse transcriptase inhibitor (NNRTI) or a protease inhibitor (PI; preferably boosted with ritonavir).

Preferred regimens

Alternative regimens

  • NNRTI-based: Efavirenz plus (lamivudine or emtricitabine) plus ( abacavir, didanosine, or stavudine)
  • PI-based
    • Atazanavir plus (lamivudine or emtricitabine) plus (zidovudine, stavudine, abacavir, or didanosine) or (tenofovir plus ritonavir)
    • Fosamprenavir plus (lamivudine or emtricitabine) plus (zidovudine or stavudine) or (abacavir, tenofovir, or didanosine)
    • Fosamprenavir/ritonavir plus (lamivudine or emtricitabine) plus (zidovudine, stavudine, abacavir, tenofovir, or didanosine)
    • Indinavir/ritonavir plus (lamivudine or emtricitabine) plus (zidovudine, stavudine, abacavir, tenofovir, or didanosine)
    • Lopinavir/ritonavir plus (lamivudine or emtricitabine) plus (stavudine, abacavir, tenofovir, or didanosine)
    • Nelfinavir plus (lamivudine or emtricitabine) plus (zidovudine, stavudine, abacavir, tenofovir, or didanosine)
    • Saquinavir/ritonavir plus (lamivudine or emtricitabine) plus (zidovudine, stavudine, abacavir, tenofovir, or didanosine)
  • Triple NRTI: Abacavir plus lamivudine plus zidovudine (only when an NNRTI- or PI-based regimen cannot or should not be used)