Postexposure prophylaxis for HIV infection

In the NEJM of October 29th, 2009, R.J. Landovitz and J. S. Currier view the manner to evaluate and treat a person who thinks he has possibly been infected by the HIV, just one or two days before.

Anti-HIV chemoprophylaxis must be started very quickly after a probable contamination and should be continued for 28 days. But before undertaking the treatment an estimation of the real risk of contamination is necessary.

The following possibilities of treatment are suggested: either 2 drugs, two nucleosides, or 3 drugs, two nucleosides plus a protease inhibitor:

Two drugs

• Ténofovir-emtricitabine, Truvada*
• Zidovudine-lamivudine, Combivir*

Three drugs

• Ritonavir-lopinavir (Kaletra*) plus Truvada* or Combivir*
• Ritonavir (Norvir*) with atazanavir (Reyataz*), plus Truvada* or Combivir*
• Ritonavir (Norvir*) with darunavir (Prezista*) plus Truvada* or Combivir*

Ritonavir is generally used as a booster for the other proteases inhibitors.

The risk of contamination by hepatitis B and C must also be taken into account.

In any case, with or without treatment, a clinical and biological monitoring must be made at 1, 3 and 6 months.

This paper can be found in free access.

See for complementary information: protease inhibitors and reverse transcriptase inhibitors.