Editing Post-exposure prophylaxis (section)

=== Treatment ===
In the case of [[HIV]] exposure, post-exposure prophylaxis (PEP) is a course of [[antiretroviral]] drugs which reduces the risk of [[seroconversion]] after events with high risk of exposure to HIV (e.g., unprotected [[anal sex|anal]] or [[vaginal sex]], [[needlestick injuries]], or [[needle sharing|sharing needles]]).<ref name="CDC">{{cite web |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm |title=Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States |last1=Smith |first1=Dawn K. |last2=Grohskopf |first2=Lisa A. |last3=Black |first3=Roberta J. |last4=Auerbach |first4=Judith D. |last5=Veronese |first5=Fulvia |last6=Struble |first6=Kimberly A. |date=21 January 2005 |work=cdc.gov |publisher=[[Centers for Disease Control]] |access-date=7 July 2011 |archive-date=14 April 2011 |archive-url=https://web.archive.org/web/20110414180947/http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm |url-status=live }}</ref> The [[Centers for Disease Control|CDC]] recommends PEP for any HIV-negative person who has recently been exposed to HIV for any reason.<ref name="CDC"/>

To be most effective, treatment should begin within an hour of exposure.<ref name="ignorance">{{cite journal |last1=Diprose |first1=P |last2=Deakin |first2=C.D. |last3=Smedley |first3=J |year=2000 |title=Ignorance of post-exposure prophylaxis guidelines following HIV needlestick injury may increase the risk of seroconversion |journal=[[British Journal of Anaesthesia]] |volume=84 |issue=6 |pages=767–770 |doi= 10.1093/oxfordjournals.bja.a013591|pmid=10895754|doi-access=free }}</ref> After 72 hours PEP is much less effective, and may not be effective at all.<ref name="CDC"/> Prophylactic treatment for HIV typically lasts four weeks.<ref name="CDC"/><ref>{{cite web |url=http://hab.hrsa.gov/tools/HIVpocketguide/PktGPEP.htm |title=HIV/AIDS Bureau - HIV Care Pocket Guide 2006 - Occupational HIV Postexposure Prophylaxis (PEP) |access-date=2008-03-05 |url-status=dead |archive-url=https://web.archive.org/web/20080311174937/http://hab.hrsa.gov/tools/HIVpocketguide/PktGPEP.htm |archive-date=2008-03-11 }}</ref>

While there is compelling data to suggest that PEP after HIV exposure is effective, there have been cases where it has failed. Failure has often been attributed to the delay in receiving treatment (greater than 72 hours post-exposure), the level of exposure, and/or the duration of treatment (lack of adherence to the 28-day regimen). In addition, since the time and level of non-occupational exposures are self-reported, there is no absolute data on the administration timeframe to which PEP would be efficacious. The standard antibody window period begins after the last day of PEP treatment. People who received PEP are typically advised to get an antibody test at 6 months post-exposure as well as the standard 3 month test.<ref name="CDC"/>

The antiretroviral regimen used in PEP is the same as the standard [[highly active antiretroviral therapy]] used to treat AIDS. A typical prescription is a 28-day course of [[emtricitabine/tenofovir]] pills containing 200&nbsp;mg of emtricitabine and 245&nbsp;mg of tenofovir disoproxil to be taken once daily, along with either 50&nbsp;mg of [[dolutegravir]] once daily<ref name=":0" /> or 400&nbsp;mg of [[raltegravir]] twice daily.<ref>{{Cite web |url=https://www.uhb.nhs.uk/Downloads/pdf/PiPepMedication28Day.pdf |title=Archived copy |access-date=2021-06-07 |archive-date=2021-06-07 |archive-url=https://web.archive.org/web/20210607084606/https://www.uhb.nhs.uk/Downloads/pdf/PiPepMedication28Day.pdf |url-status=dead }}</ref> People initiating nPEP treatment typically receive a 28-day starter pack rather than a 3–7 day starter pack, to facilitate strong [[medication adherence]].<ref name=":0" /> They should also be counseled on unpleasant side effects including [[malaise]], [[fatigue (physical)|fatigue]], [[diarrhea]], [[headache]], [[nausea]], [[vomiting]], and [[insomnia]], depending on the medication administered.<ref name="CDC"/><ref>{{Cite web |title=Dolutegravir Sodium Monograph for Professionals |url=https://www.drugs.com/monograph/dolutegravir-sodium.html |access-date=2025-01-24 |website=Drugs.com |language=en}}</ref>

People at high risk for re-exposure due to unprotected intercourse or other behavioral factors should begin [[Pre-exposure prophylaxis|PrEP]] immediately after the completion of the nPEP treatment course. Conversely, if a medically adherent patient is already taking PrEP medication upon non-occupational exposure, nPEP treatment is not necessary.<ref name=":0" />