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2014 ; 28
(11
): 1545-54
Nephropedia Template TP
gab.com Text
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English Wikipedia
Practical guidance for nonoccupational postexposure prophylaxis to prevent HIV
infection: an editorial review
#MMPMID24785956
Jain S
; Mayer KH
AIDS
2014[Jul]; 28
(11
): 1545-54
PMID24785956
show ga
Postexposure prophylaxis (PEP) with antiretroviral medication has been used as an
HIV-prevention 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.