(Truvada) plus Lopinavir/ritonavir (Kaletra) or Raltegravir (Isentress) Work Well
for Post-exposure Prophylaxis|
refers to antiretroviral therapy
(ART) taken as soon as possible -- within 48 to 72 hours -- after occupational
(e.g., accidental needle-stick) or non-occupational (e.g., broken condom) exposure
to HIV. Regimens containing zidovudine (AZT;
Retrovir) have often been used for this purpose and are the most extensively
PEP guidelines recommend efavirenz
(Sustiva) plus either zidovudine/lamivudine or tenofovir/emtricitabine as
preferred NNRTI-based regimens, and lopinavir/ritonavir plus zidovudine/lamivudine
as a preferred protease inhibitor-based regimen. Occupational
PEP guidelines are more complex, varying according to extent of exposure and
1998, Christian Rabaud and colleagues have evaluated the tolerability of 3 PEP
regimens used in France: zidovudine/lamivudine plus nelfinavir
(Viracept) twice-daily, zidovudine/lamivudine plus lopinavir/ritonavir soft-gel
twice-daily, and tenofovir/lamivudine plus ritonavir-boosted atazanavir
(Reyataz) once-daily. More recently, they added tenofovir/emtricitabine plus
November 2006 and June 2008, a total of 249 people at 10 French hospitals were
included in the study; 16% had occupational exposures, 82% had sexual exposures,
and 2% had other types of exposures.
the patients who started PEP, 11% were lost to follow-up and 14% stopped therapy
for reasons other than adverse events (including the source patient testing HIV
negative). About 9% discontinued before Day 28 (median treatment period 7 days)
due to adverse events, including 2 cases of skin rash, 1 case of kidney stones,
and 1 case of rhabdomyolysis (muscle damage).
of the study participants experienced HIV seroconversion indicating established
infection. Among the 166 people (67%) who completed the full 28-day PEP regimen,
58% reported good tolerability, 35% reported moderate tolerability, and 7% reported
poor tolerability. Among patients who experienced at least 1 side effect, 78%
reported diarrhea, 78% asthenia (weakness), and 59% nausea or vomiting.
researchers concluded that the rate of PEP discontinuation due to adverse events
"appeared significantly lower" among patients taking tenofovir/emtricitabine
plus lopinavir/ritonavir compared with the other 3 regimens.
d'Etude sur le Risque d'exposition des Soignants aux Agents Infectieux (GERES),
Paris, France; Hopital Bichat-Claude Bernard, Paris, France; Hôpital Beauregard,
Thionville, France; Centre Hospitalier Régional, Orléans, France;
Hôpital Sainte Marguerite, Marseille, France; Centre Hospitalier Régional,
Metz, France; Hôpital Bicêtre, Paris, France; COREVIH Lorraine Champagne
Ardenne, France; Centre Hospitalier et Universitaire, Nancy, France.
second study was presented by Kenneth Mayer from Fenway Community Health Center
in Boston, which has been studying non-occupational PEP since 1997. In 2008, the
center began evaluating tenofovir/emtricitabine plus the integrase inhibitor raltegravir.
In addition to being well-tolerated when used for treatment of chronic HIV infection,
raltegravir acts at an earlier stage of the HIV lifecycle than protease inhibitors.
first 51 patients treated with this regimen were all men and most were gay or
bisexual. About half each reported unprotected receptive anal intercourse and
unprotected insertive anal intercourse as routes of exposure (a majority also
reported unprotected oral sex); about 60% had sex with a partner known to be HIV
60% of the study participants completed the 28-day raltegravir PEP regimen (compared
with about 40% of patients using zidovudine/lamivudine plus a protease inhibitor)
and more than half reported complete adherence. Again, none became HIV positive.
Only 2 participants discontinued therapy due to adverse events.
significant kidney, liver, or hematological (blood) abnormalities were reported.
The most common adverse events were nausea, diarrhea, and fatigue. Men using the
raltegravir regimen reported significantly less diarrhea (29% vs 59%), nausea
or vomiting (31% vs 59%), and fatigue (10% vs 49%) than those who used zidovudine/lamivudine
plus a protease inhibitor, but were more likely to report abdominal pain, bloating,
or gas (18% vs 3%).
investigators concluded that tenofovir/emtricitabine plus raltegravir was generally
well-tolerated for non-occupational PEP and had a good safety profile.
Health, Fenway Institute, Boston, MA; Brown University, Infectious Disease Division,
Providence, RI; Harvard Medical School, Boston, MA.
Tosini, P Muller, T Prazuck, and others. Tolerability of post-exposure prophylaxis
(PEP) of HIV infection with the combination of tenofovir/emtricitabine and lopinavir/ritonavir
tablet formulation (Truvada + Kaletra). 5th International AIDS Society Conference
on HIV Pathogenesis, Treatment, and Prevention (IAS 2009). July 19-22, 2009. Cape
Town, South Africa. Abstract WEAC102.
Mayer, M Mimiaga, M Gelman, and others. Tenofovir DF/emtricitabine/ raltegravir
(TDF/FTC/RAL) appears safe and well-tolerated for non-occupational post-exposure
prophylaxis (NPEP). 5th International AIDS Society Conference on HIV Pathogenesis,
Treatment, and Prevention (IAS 2009). July 19-22, 2009. Cape Town, South Africa.