PEP Regimen Question
Mar 31, 2012
I just want to be sure this is the correct, and absolute best regimen I can be on for preventing HIV infection. I am flying home to the USA early and will get something else if this isn't the best.
I had two short sessions of unprotected vaginal sex with someone who has HIV. I took my first pills roughly 9 hours after exposure. She agreed to get tested immediately after the event and came up positive. Needless to say I am terrified.
I work in the medical industry and I am a little confused why there seems to be a random smorgasbord of regimens for pep. Surely they can't all be equal. Surely some meds are newer and better than older ones. I don't want to be on something marginally "okay" if there's better.
What is the latest, greatest, and strongest?
Response from Dr. Young
Hello and thanks for posting.
First, sounds like you were able to start your nPEP (non-occupational exposure, per se) very quickly after your exposure. This bodes well for the effectiveness of treatment in preventing HIV infection.
As for the treatment regimen, as you've said there's quite a bit of variation of recommendations. The most orthodox view is given in the various treatment guidelines. The World Health Organization (WHO) Guidelines include the use of ZDV/3TC (Combivir and others) with a HIV protease inhibitor. We'll typically use a ritonavir-boosted PI, such as ritonavir/lopinavir (Kaletra) or ritonavir/darunavir (Norvir/Prezista). Efavirenz is not generally used for PEP (in either the US or WHO guidelines) because of the relatively high rate of intolerance and risk of exposure to efavirenz-resistant virus.
Now that said, there are a variety of regimens that experienced care providers will use, based on knowledge of tolerability and risk of transmitted drug resistance. All of these regimens lack well powered clinical trials, but whose selection is base on the medications' activity in treating established HIV infection. Here in the US, tenofovir/FTC (Truvada) is often substituted for Combivir and increasingly entry inhibitors, like raltegravir (Isentress) for their better tolerability.
I hope that helps. Good luck, BY
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