Non-Occupational Post-Exposure Prophylaxis (nPEP)
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This is the provision of ARVs to individuals with significant exposure to HIV within 72 hours. This should be given especially to individuals who have been sexually assaulted where the HIV status of the assailant is unknown or in any other circumstance where there is significant exposure to HIV contaminated body fluid.
Clients who come for nPEP should be evaluated for substantial risk behaviour for HIV acquisition. Those with substantial risk or repeated requests for nPEP must be counselled for PrEP.
The ARV regimen for nPEP are the same as those for PEP due to occupational exposure as shown above.
Considerations before starting ARV therapy:
- Effectiveness of regimen.
- Potential for ser io us adverse effects and toxicity. Side effects and tolerability.
- Potential for interaction s with other drugs.
- Potential for treatment options should the initial drug combination fail.
- Cost and availability.
- Patient readiness and the likelihood of adequate adherence.
- Presence of pregnancy or the risk of becoming pregnant.
- Presence of tuberculosis and other illnesses -anaemia, peripheral neuropathy, kidney disease, hepatitis.
- Ability of the patient to return for regular and reliable follow-up
Recommended Antiretroviral Regimens
The following are the recommended 1st line and alternative ART regimens by specific populations:
Recommended ART regimens by specific populations (1st line and alternative regimens)
| Population | Description | Preferred 1st Line ART | Alternative Regime(s) |
| Pregnant & Breastfeeding women | All | TDF + XTC + DTG | TDF + XTC + EFV400 or ABC + 3TC + DTG* |
| Children (0-2 weeks) | All | AZT + 3TC + NVP** | AZT + 3TC + RAL |
| Children (2 weeks to < 5 years old) | <20 Kg | ABC + 3TC + LPV-r | AZT + 3TC + LPV-r AZT + 3TC + RAL |
| 20 – 24.9 Kg | ABC + 3TC + DTG | AZT + 3TC + LPV-r ABC + 3TC + LPV-r |
|
| ≥ 25 Kg | TAF + 3TC + DTG | ABC + 3TC + DTG | |
| ≥ 30Kg | TAF + 3TC + DTG | TDF + 3TC + DTG | |
| Children co-infected with TB | <20 kg | ABC + 3TC + RAL (Double dose of RAL) or ABC + 3TC + AZT |
AZT + 3TC + EFV (> 3 months) |
| 20 – 29.9 kg | ABC + 3TC + DTG Increase the frequency of DTG to 50mg twice daily |
ABC+3TC+LPV-r (LPV-r should be super boosted, otherwise consult expert opinion) ABC + 3TC + EFV ABC + 3TC + RAL |
|
| ≥ 30Kg | TDF + 3TC + DTG Increase the frequency of DTG to 50mg twice daily |
||
| Adolescents (10 to <19 years old) weighing ≥ 30Kg | All | TDF (or TAFc) + XTCd + DTGe | TDF (or TAFc) + XTCd + EFV400a or ABC + 3TC + DTG* |
| Adults |
- EFV 400 is the lower dose of EFV-400mg/day and is the preferred ARV agent in HIV/TB patients on TB treatment
- If NVP exposure, the alternative regimen is a PI-based therapy
- TAF is Tenofovir alafenamide. Avoid in pregnancy and HIV/TB patients on Rifampicin (currently not recommended)
- Can either be 3TC or FTC
FTC is not available as a single drug and is expected to be part of the fixed-dose combination TAF+FTC+DTG - DTG (Dolutegravir) to be given to ART naïve adolescents and adults. For HIV/TB patients on Rifampicin and cannot tolerate EFV400, increase the frequency of DTG to 50mg twice daily instead of the usual 50mg once daily where a single tablet is available
* ABC+3TC+DTG can be used as an alternative for those with renal insufficiency, or where TAF is not available and EFV is not tolerated
** Use of NVP is only for prophylaxis in infants and treatment for up to 2 weeks of age in absence of Raltegravir (RAL)