Are you PEPped and PrEPped for travel? Risk mitigation of HIV infection for travelers

Table 1 Current options for pharmacologic prophylaxis against HIV^a,b

Medication	Dose (mg)	Frequency	Comments	Guidelines
Pre-Exposure Prophylaxis (PrEP)				CDC	WHO	IAS
TDF + FTC	300/ 200	Daily	TDF- Nausea, flatulence FTC- rash, headache; distinguish from the treatment co-formulation with efavirenz	X	X	X
TDF	300	Daily	Not recommended alone in the US; whether in combination or alone, avoid in patients with renal injury or bone disease		X
non-occupational Post-Exposure Prophylaxis (nPEP)				CDC	WHO
TDF + FTC + RAL	300/ 200 400	Daily Twice daily	RAL- Mild hepatitis is common, and hypersensitivity, severe skin reactions have been reported though more common side effects include fatigue, headache, dizziness, nausea and insomnia Alternative recommendation for health adults and adolescents is TDF + FTC + DRV. In renal dysfunction, ZDV + 3TC + either RAL or DTG is recommended	X
TDF + FTC + either LPV/r or ATV/r	300/ 200 Varies	Daily	Alternatives for the 3rd drug on the TDF + FTC backbone include RAL, DRV/r, EFV		X
occupational Post-Exposure Prophylaxis (oPEP)				PHS	WHO
TDF + FTC + RAL	300/ 200 400	Daily Twice daily	The core recommendation is to take 3 or more tolerable drugs; listed alternatives for TDF + FTC include ZDV + 3TC; listed alternatives for RAL include DRV/r, ETR, RPV, ATZ/r, LPV/r; listed alternative for all is a single co-formulation of four ART medications (TDF, FTC, EVG, cobicistat)	X
TDF + FTC + either LPV/r or ATV/r	300/ 200 Varies	Daily	Alternatives for the 3rd drug on the TDF + FTC backbone include RAL, DRV/r, EFV WHO guidelines do not distinguish nPEP and oPEP		X

ATV Atazanavir, DRV Darunavir, DTG Dolutegravir, EVG Elvitegravir, ETR Etravirine, FTC Emtricitabine, 3TC Lamivudine, LPV Lopinivir, RAL Raltegravir, RPV Rilpivirine, RTV Ritonavir, /r boosting with ritonavir, TDF Tenofovir disoproxil fumarate, TDF + FTC available taken together as separate tablets or in co-formulation, ZDV Zidovudine
For post-exposure prophylaxis, IAS defers to CDC. The CDC produces the nPEP recommendations, while the United States Public Health Service (PHS) generated the oPEP recommendations
^aIndividual patient contraindications including drug:drug interactions, pregnancy, infections, chronic diseases such as renal or hepatic disease. They must be considered with each use. Providers should use applicable guidelines
^bRecommendations for children differ in the guidelines with regard to age thresholds, drug selection and dosing approach

ISSN: 2055-0936