The Journal of the Arkansas Medical Society Issue 6 Volume 115 | Page 15

Key Issues to Discuss With The Victim Before Initiating nPEP
Potential Benefits of HIV Pep
Potential Toxicities Associated With Medications (Nausea, Fatigue, Vomiting, and Diarrhea, Rash,
Myalgia, Allergic Reactions)
Instructions on How and When to Give the Medications
Importance of Adherence to the Medication Regimen
Duration of Medication Regimen, Monitoring Schedule, and Follow-Up
Plan for Accessing the Full 28-Day Supply of Appropriate Anti-Retroviral Therapy Promptly
may increase the likelihood of transmission of HIV.
This would include assault with multiple assailants,
perpetration of multiple sex acts, anal penetration,
and the presence of preexisting STIs. 5,6
Considering the HIV Status of the
Alleged Perpetrators/Source Person
Whenever PEP is initiated, the potential for
drawing HIV serology from an identified sus-
pected perpetrator should be considered. If the
alleged perpetrator subsequently is found to be
HIV negative and has no symptoms of HIV infec-
tion; discontinuation of prophylaxis of the victim
may be appropriate when in consultation with
an infectious disease specialist. In most cases,
Table 2
the alleged perpetrator is not available for test-
ing and therefore PEP should be initiated and
the 28-day course should be completed. Initial
treatment of a patient should never be delayed
pending results of serologic testing of an alleged
perpetrator. If the alleged perpetrator is known
to be HIV infected, the clinician should attempt
to obtain information of the perpetrator’s HIV
status, including viral load, medication list, and
resistance mutations. This data will be helpful in
choosing an appropriate HIV PEP regimen for the
victim. If the source person is known or suspect-
ed to have infection with HIV that is resistant to
antiretroviral medications, seek expert consulta-
tion in selecting an appropriate PEP regimen.
Decision Algorithm for Evaluation
and Initiation of Treatment
PEP is most effective when initiated as soon
as possible after HIV exposure, and it is unlikely
to be effective when instituted >72 hours after
exposure. 3,7 Therefore, persons should seek PEP
as soon as possible after an exposure that might
confer substantial risk. PEP should not be pro-
vided for frequent recurring exposure. To assist in
the determination of which patients should be of-
fered HIV PEP, the algorithm from the US Depart-
ment of Health and Human Services Working Group
on Nonoccupational Postexposure Prophylaxis is
shown below. 3
Implementing Post-Exposure Prophylaxis
When the decision to initiate PEP is made, cli-
nicians should communicate this recommendation
to the patient, considering his/her emotional state
and ability to comprehend the nature of antiretro-
viral treatment.
Antiretroviral Regimens for Pediatric/Ad-
olescent HIV Post-Exposure Prophylaxis
All persons offered PEP should be pre-
scribed a 28-day course of a 3-drug antiretro-
viral regimen. 7,8
The preferred regimen for otherwise healthy
adults and adolescents >13 years is shown below:
• Tenofovir disoproxil fumarate (tenofovir DF or
TDF) (300 mg) with emtricitabine (200 mg)
once daily
plus
• Raltegravir (RAL) 400 mg twice daily or dolute-
gravir (DTG) 50 mg daily.
• Alternative regimen for otherwise healthy adults
and adolescents is
• Tenofovir DF (300 mg) with emtricitabine (FTC)
(200 mg) once daily
plus
• Darunavir (DRV) (800 mg) and ritonavir (RTV)
(100 mg) once daily.
Health care providers considering using anti-
retroviral regimens other than those listed in these
guidelines as preferred or alternative are encour-
aged to consult with health care providers who
have expertise in HIV.
Laboratory Evaluations of
Victim of Sexual Assault
Baseline laboratory testing should be per-
formed to document HIV infection status of the
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