ALiEM - August 10th, 2018 - By: Geier C and Lin M
"Post-exposure prophylaxis (PEP) of patients who may have been exposed to HIV includes a combination HIV nucleoside analog reverse transcriptase inhibitor emtricitabine/tenofovir (Truvada) plus an integrase inhibitor. The CDC initially recommended the integrase inhibitor dolutegravir (Tivicay). However on May 18, 2018, the CDC placed an alert about the neural tube defect risk with dolutegravir.1 How does this change our ED practice?...
PEP Dosing for HIV
- Emtricitabine/tenofovir (Truvada): 200mg/300mg (1 tablet) PO daily
- Raltegravir (Isentress): 400 mg PO twice daily
Because the preventative effectiveness of these medications decline over time, it is critically important to administer the first dose of each in the Emergency Department in a timely fashion. Evidence extrapolated from animal data suggests that efficacy of HIV post exposure medications decreases greatly 72 hoursafter exposure and should not be provided."