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Recommended HIV Therapy

The recommended therapy is a three-drug regimen using the nucleotide analogue reverse transcriptase inhibitor-nucleotide reverse transcriptase inhibitor tenofovir-emtricitabine (Truvada™) and the integrase inhibitors dolutegravir (Tivicay™) or raltegravir (Isentress™) for four weeks.8 Four weeks is recommended as in vitro studies, animal studies, and occupational studies indicate this is the optimal duration oftreatment.21

These combinations of tofovir-emtricitabine and dolutegravir are recommended, but there are other regimens that are considered

Acceptable.8As with any drug therapy, medications used for post- exposure prophylaxis for HIV should be prescribed with consideration of their effectiveness and tolerability. Tolerability is especially important as the side effects of tofovir-emtricitabine and raltegravir and other post-exposure prophylaxis medications can have a negative influence of compliance with therapy.8

The potential for drug-drug interactions is also very important. Commonly used drugs such as oral contraceptives, H2receptor antagonist, and proton pump inhibitors can cause potentially serious drug interactions when used with HIV post-exposure prophylaxis drugs.

Follow-up care is essential for persons receiving post-exposure prophylaxis. The exposed person who is being treated should be re- evaluated 72 hours after the incident to determine how well she/he is tolerating drug therapy.8 Testing for HIV should be done at the time of the exposure, and 6 weeks, 12 weeks, and 6 months after the exposure;8 there may be slight variations in this schedule, depending on the test that is used. A complete blood count and measurement of hepatic and renal function should be done at the time of exposure and two weeks later.21

During the six months following the exposure, abstinence from sexual intercourse or the use of condoms is recommended, and the exposed healthcare worker should not donate blood, organs, plasma, semen, or tissues.8 These precautions are especially important in the first 6 – 12 weeks after an exposure.8