Abstract
Postexposure prophylaxis (PEP) with antiretroviral medication has been used as an HIVprevention strategy for nearly 20 years. The fact that approximately 50 000 new HIV infections occur in the United States each year reflects marked underutilization of nonoccupational PEP (NPEP). There have been several advances in NPEP in the past 10 years. Clinical trials from different countries have demonstrated better tolerability, completion rates, and fewer drug-drug interactions with newer antiretroviral agents. Notably, there has been a shift from zidovudine-based to tenofovir-based regimens. Three-drug therapy is now favored for all potential HIV exposures. More recently, the US Public Health Service and the New York State Department of Health recommended tenofovir/emtricitabine and raltegravir as the first-line regimen universally for PEP. Advances in HIV testing technology may also allow shorter duration of follow-up HIV testing after a high-risk exposure. This review will discuss challenges with previously recommended regimens, newer potential candidate agents and the rationale for using them, intervals for laboratory monitoring, and cost considerations for NPEP. NPEP can be viewed as an educable moment and a potential bridge to preexposure prophylaxis, as part of a combination prevention package, for those who are likely to have recurrent higher-risk exposures. Thus, risk-reduction counseling should be an integral aspect of NPEP.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1545-1554 |
| Number of pages | 10 |
| Journal | AIDS |
| Volume | 28 |
| Issue number | 11 |
| DOIs | |
| State | Published - Jul 17 2014 |
| Externally published | Yes |
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Keywords
- Biomedical HIV-prevention
- Nonoccupational postexposure prophylaxis
- NPEP
- Postexposure prophylaxis
ASJC Scopus subject areas
- Immunology and Allergy
- Immunology
- Infectious Diseases
- Medicine(all)
Cite this
Practical guidance for nonoccupational postexposure prophylaxis to prevent HIV infection : An editorial review. / Jain, Sachin; Mayer, Kenneth H.
In: AIDS, Vol. 28, No. 11, 17.07.2014, p. 1545-1554.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Practical guidance for nonoccupational postexposure prophylaxis to prevent HIV infection
T2 - An editorial review
AU - Jain, Sachin
AU - Mayer, Kenneth H.
PY - 2014/7/17
Y1 - 2014/7/17
N2 - Postexposure prophylaxis (PEP) with antiretroviral medication has been used as an HIVprevention strategy for nearly 20 years. The fact that approximately 50 000 new HIV infections occur in the United States each year reflects marked underutilization of nonoccupational PEP (NPEP). There have been several advances in NPEP in the past 10 years. Clinical trials from different countries have demonstrated better tolerability, completion rates, and fewer drug-drug interactions with newer antiretroviral agents. Notably, there has been a shift from zidovudine-based to tenofovir-based regimens. Three-drug therapy is now favored for all potential HIV exposures. More recently, the US Public Health Service and the New York State Department of Health recommended tenofovir/emtricitabine and raltegravir as the first-line regimen universally for PEP. Advances in HIV testing technology may also allow shorter duration of follow-up HIV testing after a high-risk exposure. This review will discuss challenges with previously recommended regimens, newer potential candidate agents and the rationale for using them, intervals for laboratory monitoring, and cost considerations for NPEP. NPEP can be viewed as an educable moment and a potential bridge to preexposure prophylaxis, as part of a combination prevention package, for those who are likely to have recurrent higher-risk exposures. Thus, risk-reduction counseling should be an integral aspect of NPEP.
AB - Postexposure prophylaxis (PEP) with antiretroviral medication has been used as an HIVprevention strategy for nearly 20 years. The fact that approximately 50 000 new HIV infections occur in the United States each year reflects marked underutilization of nonoccupational PEP (NPEP). There have been several advances in NPEP in the past 10 years. Clinical trials from different countries have demonstrated better tolerability, completion rates, and fewer drug-drug interactions with newer antiretroviral agents. Notably, there has been a shift from zidovudine-based to tenofovir-based regimens. Three-drug therapy is now favored for all potential HIV exposures. More recently, the US Public Health Service and the New York State Department of Health recommended tenofovir/emtricitabine and raltegravir as the first-line regimen universally for PEP. Advances in HIV testing technology may also allow shorter duration of follow-up HIV testing after a high-risk exposure. This review will discuss challenges with previously recommended regimens, newer potential candidate agents and the rationale for using them, intervals for laboratory monitoring, and cost considerations for NPEP. NPEP can be viewed as an educable moment and a potential bridge to preexposure prophylaxis, as part of a combination prevention package, for those who are likely to have recurrent higher-risk exposures. Thus, risk-reduction counseling should be an integral aspect of NPEP.
KW - Biomedical HIV-prevention
KW - Nonoccupational postexposure prophylaxis
KW - NPEP
KW - Postexposure prophylaxis
UR - http://www.scopus.com/inward/record.url?scp=84904728246&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84904728246&partnerID=8YFLogxK
U2 - 10.1097/QAD.0000000000000301
DO - 10.1097/QAD.0000000000000301
M3 - Article
C2 - 24785956
AN - SCOPUS:84904728246
VL - 28
SP - 1545
EP - 1554
JO - AIDS
JF - AIDS
SN - 0269-9370
IS - 11
ER -