Postexposure HIV Treatment Guidelines

Postexposure prophylaxis used to prevent HIV infection is divided into two major treatment groups: those who are occupationally exposed, such as doctors and nurses (PEP), and those who are nonoccupationally exposed (nPEP). nPEP is not a common treatment, simply because if there has been nonoccupational exposure, then it was likely due to something within the individual's lifestyle. Lifestyle-related exposure has a much higher chance of occurring multiple times, while doctors or nurses having accidental exposure is not likely to occur more than once. Both forms of postexposure treatment follow similar procedures and will share benefits and disadvantages.

PEP

• Several different short-term treatment regimens are available for a postexposure course of antiretroviral treatment, though most doctors continue to use AZT and 3TC, often in the form of Retrovir and Epivir taken twice daily for a total of 1200 mg per day. Another commonly used regimen is a short course (about 4 weeks) of Combivir, which is a tablet containing 300 mg AZT and 150 mg 3TC that is taken twice per day. There are other combinations available as well, but this particular combination has fewer serious side effects and less of a chance of toxicity to the organs when taken short term.

nPEP

• Nonoccupational postexposure prophylaxis is generally not prescribed by doctors due largely to the reason for exposure, the side effects of ARV drugs and accompanying adherence issues for noninfected individuals. Should nPEP treatment be prescribed, patients follow a similar drug regimen as for occupational exposure: Retrovir and Epivir twice per day, or Combivir twice per day. This treatment needs to be continued for a full 4 weeks.

Advantages and Disadvantages

• The advantages of a short course of antiretroviral medication to avoid HIV infection are easy to see. The Combivir method is relatively safe and nontoxic for short runs, is safe to take during pregnancy if a pregnant woman has been put at risk for HIV infection, and side effects from the drug are usually both predictable and manageable. The AZT found in Combivir has been used in more trials than other drugs, so it has been proven more often to be effective than other ARV treatments. However, even though the side effects follow a predictable course, they can still be relatively severe. Side effects can include nausea and vomiting, diarrhea, headache and fatigue and can all range from fairly mild to severe and can even result in further problems stemming from dehydration. More importantly, severe side effects often contribute to poor adherence, which could cause prophylactic failure and (if infected) viral resistance.