United States guidelines

The United States government announced public health guidelines for the use of non-occupational PEP in January 2005.¹

Unlike the UK guidelines, the US guidelines state that any triple-drug antiretroviral regimen approved by the Department of Health and Human Services may be used. They also suggest that a dual nucleoside reverse transcriptase inhibitor (NRTI) regimen may be sufficient for lower-risk exposures as they maintain that there is no evidence for the increased effectiveness of an extra drug, particularly in the face of increased risk of side-effects.

They also recommend one drug specifically ruled out by BHIVA and EAGA: efavirenz. Preferred regimens are efavirenz with either tenofovir/FTC (Truvada) or AZT/3TC (Combivir, or alternatively boosted lopinavir (Kaletra) with either Combivir  or AZT/FTC. This may be modified if details of the source patient’s treatment history or resistance profile are available. The United States guidelines advise against the use of nevirapine, and of efavirenz in women of childbearing age.

The US recommendations include care for patients for up to six months following exposure, to determine whether HIV infection has occurred, as well as tests for hepatitis B and C co-infection, STIs and pregnancy.

While European and United States guidelines agree that treatment should be given for 28 days when the source is known to be HIV-positive, they differ when the source’s HIV status is unknown. The United States recommendations suggest deciding whether to administer PEP on a case-by-case basis.