Antiretroviral regimens for post-exposure prophylaxis following an exposure to HIV

* The approach to regimen selection in patients with reduced kidney function can vary and is discussed in the topic reviews on occupational and nonoccupational exposures to HIV. If tenofovir disoproxil fumarate and emtricitabine are used in individuals with an estimated glomerular filtration rate <50 mL/min, the dosage of tenofovir disoproxil fumarate and emtricitabine should be adjusted based upon kidney function, and coformulated tablets cannot be used. For specific dosing recommendations, refer to the individual Lexicomp drug monographs available in UpToDate.
¶ Dolutegravir should not be prescribed to any person of childbearing potential who is sexually active or has been sexually assaulted and was not using an effective birth control method. It should also be avoided in persons early in pregnancy (eg, eight weeks since last menstrual period). Preliminary reports suggest an increased rate of neural tube defects in infants born to women who received dolutegravir at the time of conception. Additional information on regimen selection in this population can be found in the topics that discuss management after a potential exposure to HIV.
Δ There is an increased risk of drug interactions if a regimen using a boosting agent (ie, cobicistat or ritonavir) is administered. In addition, regimens that contain tenofovir disoproxil fumarate and cobicistat should only be administered to individuals with an estimated glomerular filtration rate ≥70 mL/min.
◊ Elvitegravir-cobicistat-emtricitabine-tenofovir disoproxil fumarate and other cobicistat-containing regimens should not be used in persons of childbearing potential who desire pregnancy or in those who are pregnant due to decreased drug levels during pregnancy.
§ In general, we prefer darunavir boosted with ritonavir or the coformulated tablet darunavir-cobicistat if a protease inhibitor is used. However, darunavir should generally be avoided in patients with a sulfonamide allergy. Atazanavir boosted with ritonavir or the coformulated tablet atazanavir-cobicistat can be used as an alternative.