BOX 3.

Post-exposure prophylaxis recommendations.

In adults and adolescents ≥35 kg:

The preferred backbone for PEP is TDF + FTC/3TC.† Raltegravir (RAL) is the preferred third drug (except in pregnant women, where ATV/r is the preferred third drug). Alternative third drugs include ATV/r, LPV/r, DRV/r or EFV. It is imperative that the first dose of PEP is administered as soon as possible after exposure; if the 3 recommended drugs are not immediately available, use whatever suitable ARV medication is available to start. All PEP regimens must be administered for one month.

PEP, post exposure prophylaxis; TDF, tenofovir; FTC/3TC, emtricitabine/lamivudine; RAL, raltegravir; ATV/r, atazanavir/ritonavir; LPV/r, lopinavir/ritonavir; DRV/r, darunavir/ritonavir; EFV, efavirenz; ARV, antiretroviral.

†, AZT is poorly tolerated in PEP settings, whilst TDF + FTC/3TC has a better safety profile, and is similar in cost to AZT + 3TC. TDF + FTC/3TC is also recommended for PrEP. Owing to poor tolerability of AZT in PEP, d4T is well tolerated in short-term use and should be used where TDF is contraindicated.