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Post-Exposure HIV Prevention: Needles, Sex, and Drugs

Estimates of Per-Exposure Infection Risk
	% Probability	95% Cl
Percutaneous occupational exposure Gerberding 96 (pooled data)	0.32	0.18-0.46
Sharing needles Kaplan & Heiner 92	0.67	(not provided)
Receptive anal intercourse DeGrutolla 89 DeGrutolla 89	0.80	0.5-1.1
Receptive vaginal intercourse Peterman 96/Wiley 89 Padia 91/Wiley 89 Downs 96	0.14 0.07-0.10 0.05-0.15	0.05-0.23 0.03-0.17 0.03-0.07

PEP Treatment Regimens

Basic Regimen

Zidovudine (ZDV): 200mgtid (300 mg PO bid)
Lamivudine (3TC): 150mg bid (125 mg bid If <60kg)

Protease Inhibitor

Indinavir (IND): 800 mg q8h
or Nelfinavir (NEL): 750 mg tid

(if needed to ensure 2 new antiviral drugs or for very risky exposure)

Alternate PEP Treatment Regimens

Alternate Regimen I

Didanosine (DDI): 200 mg bid (125mg bid if <60 kg)
Stavudine (D41): 40 mg bid (30 mg bid if <60 kg)

Alternate Regimen II

Stavudine (D4T): 40 mg bid (30 mg bid lf <60 kg)
Lamivudine (3TC): 150 mg bid (125 mg bid if <60 kg

Current Post-Exposure Prophylaxis (PEP)

Initiation: ASAP after potential exposure still treat serious exposures even after 72 hours

Duration: 4 weeks
Monitor Labs: baseline, q 2 wks on treatment (or until all labs normalize)

HIV antibody: baseline, 6 wks, 3 mo, 6 mo, (12 mo)

HIV PCR: only with acute HIV symptoms