August 1, 2013
Posted August 2013
Here is important information from the Office of the Medical Director (OMD) AIDS Institute:
The NYSDOH AIDS Institute has released updated guidelines for HIV Prophylaxis Following Non-Occupational Exposure, available here.
Significant revisions include the following:
The Medical Care Criteria Committee now recommends tenofovir + emtricitabine* and raltegravir as the preferred initial nPEP regimen because of its excellent tolerability, proven potency in established HIV infection, and ease of administration. Zidovudine is no longer recommended in the preferred PEP regimen because it is believed to have no clear advantage in efficacy over tenofovir while having significantly higher rates of treatment-limiting side effects.
If the source person’s HIV screening test result is negative but there has been a risk for HIV exposure in the previous 6 weeks, plasma HIV RNA testing of the source person is also recommended. In this situation, nPEP should be initiated and continued until results of the plasma HIV RNA assay are available.
Updates to the table of types of exposures that should prompt consideration of nPEP and those that do not warrant nPEP have been added.
A chart has been added showing both the risk of HIV transmission for various exposures as well as factors that may increase transmission risk.
Baseline STI testing is recommended for sexual exposures that do not occur as a result of sexual assault. STI management recommendations, including prophylactic treatment, differ for cases of sexual assault.
Recommendations for follow-up HIV testing of the exposed person have been changed. Regardless of whether the exposed person accepts or declines PEP treatment, if the post-exposure evaluation determines that nPEP is indicated, repeat HIV testing at 4 weeks and 12 weeks should be obtained. A negative HIV test result at 12 weeks post-exposure reasonably excludes HIV infection related to the exposure; routine testing at 6 months post-exposure is no longer recommended.
* Lamivudine may be substituted for emtricitabine.