CDC Releases Updated Guidelines on HIV Nonoccupational Post-Exposure Prophylaxis

According to a recent Morbidity and Mortality Weekly Report announcement, the Centers for Disease Control and Prevention (CDC) has released updated guidelines for the use of nonoccupational post-exposure prophylaxis (nPEP) in persons in the United States, after exposure to human immunodeficiency virus (HIV) outside the health care setting.

The 2016 guidelines provide updated recommendations to help US clinicians provide nPEP to patients after they experience a single exposure to blood, genital secretions, or other body fluids that may contain HIV—in order to reduce the development of new HIV infections.

Evidence for the new recommendations comes from recent data from studies involving animals and humans.

One of the key points highlighted in the new guidelines is the need for clinicians to promptly assess patients for nPEP when they present within 72 hours after a potential nonoccupational exposure to HIV. According to the guidelines, studies have shown that “using antiretroviral medication initiated as soon as possible ≤72 hours after sexual, injection drug use, or other substantial nonoccupational HIV exposure and continued for 28 days might reduce the likelihood of HIV acquisition.” Although nPEP is recommended if the source of the body fluids is known to be HIV-positive and the exposure presents a substantial risk for transmission, nPEP is not recommended if the exposure presents no substantial risk of HIV transmission, or if the patient presents for care more than 72 hours after potential exposure.

If nPEP is indicated, the guidelines recommend laboratory testing using rapid antigen-antibody combination HIV tests, and prescription of a 28-day course of emtricitabine/tenofovir disoproxil fumarate plus raltegravir or dolutegravir for healthy adults and adolescents.

The guidelines provide updates to the schedule of laboratory tests of source and exposed persons, and to the antimicrobial regimens for prophylaxis of sexually transmitted infections and hepatitis. They also include information about new and better-tolerated antiretroviral medications that were approved since the 2005 guidelines, dosing information for pediatric patients, and a suggested procedure for transitioning patients between nPEP and HIV pre-exposure prophylaxis.

“These guidelines are intended to assist US healthcare providers in reducing the occurrence of new HIV infections through the effective delivery of nPEP to the patients most likely to benefit,” the guidelines note.

In addition, the CDC hopes that a wide range of medical professionals and other individuals will also adopt the updated guidelines—including emergency medical technicians, social workers, managers of health insurance plans, anyone who cares for sexual assault survivors, and individuals with HIV and their partners.

“As new medications and new information regarding nPEP become available, these guidelines will be revised and published,” the guidelines conclude.

Dr. Parry graduated from the University of Liverpool, England in 1997 and is a board-certified veterinary pathologist. After 13 years working in academia, she founded Midwest Veterinary Pathology, LLC where she now works as a private consultant. She is passionate about veterinary education and serves on the Indiana Veterinary Medical Association’s Continuing Education Committee. She regularly writes continuing education articles for veterinary organizations and journals, and has also served on the American College of Veterinary Pathologists’ Examination Committee and Education Committee.