antiviral treatment for chronic infection was available. Prophylaxis was primarily after used occupational exposures. The useofpost-exposure prophylaxis (PEP) against HIVinfection dates backto theearly whenonly 1990s, limited Introduction 7. exposures were 81% less likely to undergo seroconversion for to positivity HIV. A case–control study in1997 published that showed health care workers whoreceived zidovudine after needlestick data have led towidespread its acceptance. for prophylaxis against infection. data Noefficacy are available for this strategy, butsubstantial safety and feasibility After exposure to HIVthrough contact sexual druguse,antiretroviral orinjecting therapy may alsobeadministered prescribed nowadays, socurrent HIVPEPmay bemore effective. However, PEPisnot aguarantee ofprotection. (*including co-factors suchassexually transmitted infections, highHIVviral load andbleeding). Risk ofHIVtransmission =riskthat source isHIV-positive xriskofexposure* positive where unknown, andtheriskofinfection followingexposure aspecific from anHIV-positive individual. The riskofanindividualacquiringHIVfollowing anexposure isdependent upontheriskthat thesource isHIV- Risk assessment 6. 5. 4. 3. 2. 1. Key points HIV Post-Ex prophylaxis (PEP) 7HIVPost-exposure (updated -Appendix EMI Guidelines June2018) -36- justified in the majority of such exposures. ofsuch justified inthemajority If theHIVstatus of thesource is unknown,acareful should riskassessment out.PEPisunlikely becarried to be thatconcluded HIVinfection ofthesource isunlikely. PEP should not be offered where testing hasshownthat thesource isHIVnegative, has oriftheriskassessment within 2hoursifpossible. known HIVpositive personorasuspectedhighrisksource. The first of PEP should dose be given assoonpossible - HIV PEPshould only beconsidered inpatients whopresent within72 hourswithasignificantexposure from eithera General principles C Discuss withseniordoc T relevant appendices) Asse The firs Onl If PEPindic e. d. c. a. b. est source if feasible omplete thepatient asachecklist management form (appendix1)–itwillserve y considerPEPifwithin72 hoursofexposure A Arr P T C ss risk based on type ofexposure andwhat ontype isknownaboutsourcess riskbased (consider riskofHBV also–see andHCV est blood and urine rescribe starter pack ounsel dvise nounprotected for sex 3months t dose ofPEPshouldt dose begiven assoonpossible -within2hoursifpossible ange follow upat IDorGUMclinicbefore starter packrunsout ated: tor inemergency orHIVspecialist medicine ifunsure howto proceed p osur 3 1
e Pro ph ylax 2 Generally, combination are therapies i s (PEP) 4 4 1
toolkit § ‡ † % *MSM=men whohave withmen sex unknown Table 2Estimated riskofHIVtransmission where source ofexposure HIVstatus by type is 1997. five documented and cases 31 probable probable eight ofthese cases, prior beingdiagnosed to cases The overall inHCWs intheUKdiagnosed numberofHIVcases following occupational exposuresis transmission suchashighviral load inthesource, andintercurrent STIs, e.g.syphilis. The table above issimply aguide. There are anumberoffactors that may increase theriskof failure hasoccurred NB: All sexually related riskprobabilities are for unprotected similarriskswillexist where itisassumed exposure; sexual condom (Adapted from BASHH UKGuidelinefor 2015 useofHIVPEPSE Table 1RiskofHIVtransmission from perexposure aknownHIV-positive individualnot onART & PWID=people drugs whoinject NSI=needlestick injury Health Research Board. Personal communications: DrShay Keating, Drug Treatment Centre Board andDrJean Long, Alcohol andDrugResearch Unit, ( noteOf there anincrease hasbeen inthenumberof recent HIVinfections amongst diagnosed PWID inDublin 2015 Jul-Aug;108(7):199-202). in Dublin.(Patients Care forAccessing Ambulatory HIV-infection: Epidemiology and Prevalence Assessment. Tuite Het J. al.IrMed note,Of theprevalence HIVvaries geographically ofdiagnosed inIreland withcrude prevalence amongst 17-78 of 2.0/1000 year olds Human bite chemsex) (includes equipment Sharing injecting injury Needlestick Blood transfusion (one unit) oral fellatio) sex(receiving Insertive Receptive oral sex(giving fellatio) splashtoeye Semen 1in909 vaginal intercourse Insertive 1in161 Receptive vaginal intercourse Insertive analintercourse andcircumcised 1in170 Insertive analintercourse not circumcised analintercourse Insertive 1in65 Receptiveanalintercoursenoejaculation Receptiveanalintercoursewithejaculation Receptive analintercourse Type ofexposure http://www.hpsc.ie/A-Z/HIVSTIs/HIVandAIDS/HIVPeoplewhoinjectdrugs/MainBody,15231,en.html) MSM* Receptive analsex yeo xoue Population group Type ofexposure NSI source high riskhospital pt MSM* Receptive oral sex MSMinIreland Insertive MSM* analsex NSI Heterosexuals in Receptive vaginal sex † † 5 from community from unknownnon
toolkit Appendix 7 HIV Post-exposure prophylaxis (PEP) 7HIVPost-exposure (updated -Appendix EMI Guidelines June2018) (8%) MSM inIreland (% HIVprevalence) PWID Ireland (0.15%) Heterosexuals in (5 to10%) (8%) MSM inIreland (8%) Ireland (0.15%) 6 6 6 ‡ inIreland 8,9,§,&
7,% 7,%
4 – source references omitted from table) HIV status unknown Risk ofHIVtransmission -source 0.15/100 x 1/1000 = 1/666,666 1/700,000 (1/1000) 1/700,000 0.15/100 =1/666,666 x1/1000 0.15/100 x 1/333 = 1/222,000 1/200,000 (1/333) 1/200,000 0.15/100 =1/222,000 x1/333 (<1/10,000) 1/100,000 =1/125,000 x1/10,000 8/100 circumcised) =1/2012(not x1/161 8/100 x1/666 = 1/8325 (overall)8/100 x1/90=1/1125 8/100 10/100 x 1/333 =1/3330 x1/333 10/100 =1/6660 to x1/333 5/100 <1 in10,000 1 in149 1 in333 1 in <1 in10,000 <1 in10,000 <1 in10,000 1 in1,219 1 in1000 1 in666 1 in90 from aknownHIV-positive individualnot onART Estimated riskofHIVtransmission perexposure source knownHIV+) (compared withriskif risk perexposure Rounded offestimated 1/2000 (1/161) 1/2000 1/8000 (1/666) (1/90) 1/1000 (1/333) to 1/3000 1/7000 -37- UK. The last rows are two not contained intheBASHH Guidelinetable) risk, e.g. isthesource from ahigh riskgroup suchasPWID, ofhigh prevalence. MSMorfrom acountry possible to give reassurance that theriskofHIVinfection iszero. However, itmay bepossible to estimate • for HIV Ag/Ab &30). 29 (andHBsAg, anti-HBc andanti-HCV)(appendices If thesource isknown, theexposure should to beoutlined thesource andconsent requested for blood to test effort In thecase should ofasignificantexposure, every bemade to ascertain theHIV status ofthesource. Estimating that source probability isHIVpositive *** § ** ‡ % † & evalence groups withinthisrecommendation are where those there isasignificant likelihood ofthesource individualbeingHIV- * (Adapted from BASHH UKGuideline2015 1000 orgreater, basis. onacase-by-case are considered butallcases It isgenerally that HIVPEPisonly recommended offered transmission whentheestimated riskis1in prophylaxis (PEP) 7HIVPost-exposure (updated -Appendix EMI Guidelines June2018) -38- If thee • Table andsource ofexposure status 3HIVPEPrecommendations by type exceptional circumstances. 1in1,000and10,000onlywith ariskofbetween invery PEP isnot recommended for individualsreceiving fellatio, oral cavity i.e.insertingtheirpenisinto another’s areas/groups ofparticularly highHIVprevalence More detailed knowledge oflocal prevalence recommendations may changethese ofHIVwithincommunities from recommend consider to in A bite to isassumed constitute breakage oftheskinwithpassage ofblood HIV prevalence (particularly sub-Saharan Africa) mapofglobal (See HIVprevalence, appendix26) positive. Within Ireland at present, thisislikely to bemenwhohave withmen,andindividualswhohave sex immigrated from areas ofhigh High pr Where source HIVviral load ishigh(e.g. recent seroconversion) orwhere there ofgenital isevidence ulceration Consider where recent ulceration seroconversion ortrauma. oforopharyngeal orevidence should beoffered Provided source’s HIVviral load isundetectable for >/=6months. Where there isuncertainty aboutresults ormedication adherence, PEP skin, eye or mouth Blood splashto non-intact Human bite Fellatio withejaculation Insertive vaginal sex Receptive vaginal sex source Needlestick direct from Fellatio withoutejaculation needle inthecommunity Needlestick from adiscarded Insertive analsex paho ee noeeNtrcmeddNtrcmeddNtrcmeddNot recommended Not recommended Not recommended equipment Not recommended Sharing ofinjecting Cunnilingus Splash ofsemeninto eye Receptive analsex if thesource isonanti HIVmedication. Ifnot contactable, commencestandard PEP. not completely eliminate theriskoftransmission. PEPshould withthetreating bediscussed IDconsultant the source self-reports ofHIV. adiagnosis A low orundetectable HIVviral load greatly butdoes diminishes The s risk ofinfection. no clinical indication ofaretroviral/ seroconversion-like andsource illness, isnot considered to beat high The s Denotes parts oftableDenotes parts that differ from BASHH Guideline if they haveource ifthey apositive HIVresult, is considered HIVpositive HIVor hasdiagnosed oraphysician ource isconsidered HIVnegativeifthere isarecent HIVnegative result withinthepast 3months plus xposure involves witheitherunknownxposure HIVstatus a source itisnot orunknown person identity *** § *** ‡ ‡ Consider Recommend appendix 6) Bite(see algorithm, Recommend Consider Recommend Not recommended Not recommended Not recommended circumstances limited Consider invery Not recommended Not recommended Recommend Not recommended Not recommended Not recommended Not recommended Recommend HIV VL unknown/ 4 – modified –modified to take account ofhigherprevalence ofHIVinPWIDpopulation inIreland compared to detectable % ***
HIV positive ** Not recommended o eomne o eomne Not recommended Not recommended Not recommended Not recommended HIV V Provided source confirmed has o eomne o eomne Not recommended Not recommended Not recommended Not recommended o eomne o eomne Not recommended Not recommended Not recommended Consider Not recommended Consider Not recommended Not recommended undetectable L <200c/ml for >6months HIV VL Source HIVstatus Source & & & & 4 algorithm, appendix3) Needlestick/Sharps circumstances limited Consider invery Consider Consider Consider Recommend PEPcan beconsidered inthose From high prevalence country /risk-group* country † † † † † *** Unknown HIVStatus (see (see Not recommended Not recommended Not recommended Not recommended Not recommended Not recommended Not recommended From low prevalence country /group country
toolkit Table investigations 4Baselinerecipient PEP priortoprescribing BBV exposure –recipient”. Baseline investigations priorto prescribing PEPare intable outlined 4. Blood samples should belabelled “Possible Baseline investigations HIVPEP priortoprescribing ofrecipient Give therecipient aHIVPEPinformation leaflet (appendix 31) • • • • istakenIf adecision to prescribe PEP, therecipient should beadvised: to give PEP Decision STI clinicasappropriate (appendix35). If PEPisnot to begiven,why. explain Arrange for follow-up to outby becarried aGP, or occupational health service not to give PEP Decision Give therecipient aninformation leaflet aboutsignificantexposures (appendix 28). • • • • • The estimated HIVrisk ofPEP.the risksandbenefits Thecounsellingshould cover: recreational drugs)before prescribing HIVPEP. complete (including herbalremedies, vitamins/minerals, afull over medication history and thecounter medicines Overall the drugs chosen for HIV PEP pose a relatively low risk for interactionsdrug-drug but as with all prescribing, Interactions Drug-drug • • • • • • • Key points HIVPEP Prescribing I Counselling prevalence inPWID). 25&26onHIVepidemiology appendices andriskoftransmission,(See andmapsofglobal HIVprevalence and f theriskofHIVisestimated to behighandPEPisbeingconsidered, therecipient should receive counsellingon Syphilis Hepatitis HIV testing Urinalysis test Pregnancy Safety bloods blood results ontherecipient orthesource. (table 4) The first ofPEPshould dose to begivenwait assoonpossible -within2hoursifpossible. Itisnotfor necessary alternatives are and they widely internationally used andaccepted asbestpractice. It isimportant to note that antiretrovirals are inIreland unlicensed for PEP. However, there are nolicensed physician. at high riskofrecent infection, inwhich case, continuation ofPEPshould only adviceofaHIV beontheexplicit PEP should bediscontinuedimmediately ifaHIVtest onthesource isfound to benegative, unless thesource is In general, dolutegravir should not inearly beused pregnancy orin womenofchildbearing potential. proteinuria, prescribing special see situations below. Ensure baselinesafety bloods are before withinnormallimits discharge. Ifthere isrenal impairment or Only start PEPwithin72 hoursoftheriskevent. Discuss withseniordoctor inemergency orinfectious medicine ifunsure diseases howto proceed. That only astarter packisbeingprescribed. sideeffectsThe expected The importance ofadheringto theprescribed medication The windowperiod. of earlyThe benefits identification versusthe implicationspositive ofa result applicationnew The possible requirement to inform insurer ofapositive test result, asisapplicable for orfor anexisting policy a The potentially serious adverse reactions to PEPwhichmust against bebalanced theriskofHIVinfection How to take themedication
toolkit Appendix 7 HIV Post-exposure prophylaxis (PEP) 7HIVPost-exposure (updated -Appendix EMI Guidelines June2018) If sexual exposureIf sexual HBsAg, anti-HBc, anti-HCV HIV Ag/Ab Dipstick for proteinuria Urine strip LFTs, U&E, FBC, profile Bone home prior todischarge Must bereviewed -39- Appendix 7 HIV Post-exposure prophylaxis (PEP) 7HIVPost-exposure (updated -Appendix EMI Guidelines June2018) Abstract/1203) prophylaxis men.McAllister ingay andbisexual Jet al. Available at http://programme.aids2016.org/Abstract/ daily, atotal of2tablets/day. (Dolutegravir withtenofovir disoproxil fumarate-emtricitabine asHIVpost-exposure concomitant medications. willbedictateddecision by anumberoffactors, includingpotential interactions drug-drug between andother Tivicay® treatment ormay have theIsentress® switched to attend whenthey theID/HIVTivicay® orSTI clinic for follow-up. The Patients who have started been onthestandard starter pack,may continue onthisregimen to complete of the4 weeks Truvada® (tenofovir/emtricitabine) onebluetablet daily, plus Tivicay Or (Note: Ingeneral, dolutegravir isnot recommended inearly pregnancy orinwomenofchildbearing potential) daily, atotal of3tablets/day. Truvada® (tenofovir/emtricitabine) onebluetablet daily, plusIsentress® 400mg(raltegravir) 1pinktablet twice Standard Regimen STI/ID clinic: advice onhowto deal withthemshould beprovided to thepatient (appendix31). PEP before thestarter packrunsout. A leafletexplaining thecontents ofthepack,possibleeffects side andbrief All medications must bereviewed by anID/HIV specialist oraclinicianwithsignificantexperience inmanagingHIV www.medicines.ie) SmPC, immediately. Isentress® tablets however, should beswallowed whole andnotbroken chewed, (Isentress® orcrushed inswallowing,difficulty Truvada® inapproximately can bedispersed 100mlof water ororange juiceand taken Truvada® should betaken withfood asthisimproves tenofovir absorption andmay reduce nausea. Ifpatients have daily, atotal of3tablets/day. Truvada® (tenofovir/emtricitabine) onebluetablet daily, plusIsentress® 400mg(raltegravir) 1pinktablet twice Pack day (ED/SATU): Starter Standard 3-5 Medications -Adults www.hiv-druginteractions.org andwww.medicines.ie. Additional resources includetheproduct insertfor thedrug,BritishNational Formularly, concentrations. Dolutegravir iscontra-indicated withdofetilide dueto potential life-threatening toxicity by caused highdofetilide and stopping dolutegravir to maintain glycaemic control. Dolutegravir increases theconcentration ofmetformin adjustment andadose should beconsidered whenstarting carbamazepine, oxcarbazepine orSt.John’s Wort isrequired. Increase ofdolutegravir thedose to 50mg12hourly ifco-administration withrifampicin, phenytoin,phenobarbital, Dolutegravir. containing antacids (whichreduce theabsorption ofdolutegravir) at least 2hoursafter or6hoursbefore : Dolutegravir Advise patients to take calcium andiron supplements, multivitamins andaluminiummagnesium cytochrome P450 withthestandard inducerscan beused ofraltegravir. dose Increase ofraltegravir thedose to 800mg12hourly ifco-administration withrifampicin isrequired. Other aluminium, whichcan reduce theabsorption ofraltegravir) duringPEP. Prescribe aPPI/H2antagonist ifrequired. Raltegravir: Advise patient to stop antacids andmultivitamins (products containing metal cations e.g.magnesium/ Truvada: There are nosignificant interactions drug-drug with Truvada. -40- Once daily Truvada® Once daily Truvada® PLUS PLUS Isentress® Isentress® Evening Morning Evening Morning OR Tivicay® Once daily ® 50mg(dolutegravir) oneyellow tablet once
toolkit 4. 3. 2. 1. Counsel andadvisethefamily, andprovide information leafletseffects outliningside ofmedication. shouldThe riskassessment beasperadults. The treatment below. isoutlined 2016) Hospital, Crumlin, February (Adapted from Post Exposure Prophylaxis for (PEP) Guidelines children andadolescents potentially to HIV. exposed Children’s Ourlady’s Medications -Children arrangements should berecorded inthepatient’s notes. complete thepatient management form asareferral (appendix1). This willserve form for thespecialist clinic.Follow-up before Note: Starter thestarter packsare not packrunsout(appendix34). inpaediatrics. used The doctor should significantexperience inmanagingHIVPEP. Anurgent referral should bemade to ensure that thisvisit takes place A recipient started onHIVPEPshould bemonitored by inHIVtreatment aclinicianspecialising oraclinicianwith Follow-up regarding precautions. Advise therecipient to adopt safe practices (i.e.usecondoms)for sex ofmainguidelines 6.2 section 3months. See Precautions 5. 4. 3. 2. 1. situations Prescribing Special all available at www.medicines.ie ) can befound ofproduct intherelevant characteristics (Truvada® summary Isentress® and SmPC SmPC, SmPC Tivicay® effects should contact their doctor. Further information andpotential ondosing sideeffects interactions anddrug-drug depression, rash, pruritus, elevations in ALT andCKare reported ascommonsideeffects. Patients side experiencing andGIdisturbance commonsideeffects.Headache, dizziness are Insomnia,abnormaldreams, reported asvery include rash, renal impairment andhepatoxicity. Patients sideeffects experiencing should contact theirdoctor. Tivicay®: Truvada® andIsentress®: GIsideeffects are common.Headache iscommon.Severe sideeffects are uncommon,but Potential SideEffects: taken withorwithoutfood. immediately. Isentress® tablets, however should beswallowed whole andnot broken chewed, orcrushed. can be Tivicay® inswallowing,difficulty Truvada® inapproximately can bedispersed 100mlof water ororange juiceand taken Truvada® should betaken withfood asthisimproves tenofovir absorption andmay reduce nausea. Ifpatients have Raltegravir 400mg(Isentress®) 1tablet daily twice + Truvada® 1tablet daily. Young people from 10years ofage and over 35Kg whoare able to swallow tablets should receive PEPasfor adults: Tenofovir TDF should beavoided inthecontext ofrenal impairment at any ageifat allpossible advice). expert (seek 300mg (Combivir®) 1tablet daily. twice given :Raltegravir 400mg(Isentress®) 1tablet daily twice +fixed combinationLamivudine 150mg/Zidovudine dose of Young people 10years ofageorolder withrenal should insufficiency not receive Tenofovir andshould therefore be Raltegravirexpert advice). as first line.(seek children inthis agegroup islimited. Kaletra® remains analternative inchildren under 6years ofagewithchewable Although Raltegravir iscurrently inchildren licensed younger than6years andweighing>11Kg, ofuse in experience alone. This should always first bediscussed withanID/HIV specialist. Patients unable to tolerate PEP: Inexceptional 3-drug circumstances theregimen can beswitched to Truvada® breastfeeding orconsideringbreastfeeding, thisshould withanobstetrician bediscussed oranID/HIV specialist. Breastfeeding: Breastfeeding isgenerally not recommended while taking PEP. Ifthepatient iscurrently women ofchildbearing potential. Ensure urgent specialist follow up Pregnancy: Ifindicated, commencesame PEP. Ingeneral, dolutegravir isnot recommended inearly pregnancy orin creatinine not butdoes cause renal to impairment adjusted bedose orneed inrenal impairment. for adjustment. dose Isentress®can begiven. may alterTivicay® creatinine excretion leading to anincrease inserum Renal impairment orproteinuria: Give first of dose Truvada® anddiscusswithID/HIV specialist regarding theneed commence standard starter packandensure follow upwithID/HIV specialist urgently. Source isknownto beHIVpositive andonantiretroviral drugs:DiscusswithID/HIV specialist. Ifnot contactable,
toolkit Appendix 7 HIV Post-exposure prophylaxis (PEP) 7HIVPost-exposure (updated -Appendix EMI Guidelines June2018) -41- Appendix 7 HIV Post-exposure prophylaxis (PEP) 7HIVPost-exposure (updated -Appendix EMI Guidelines June2018) Table PEPregimens 5Suggested be promptly sourced from another centre. paediatric HIVPEPpreparations instock orhave formal arrangements inplacewhereby thedrugscan individual’s bodysurface area. Itisrecommended that allcentres should withpaediatricunits have are asdrugsare not andnot starter packs inuse recommended accordingPaediatric dispensed to the Surface area calculation: Accurate weight andheight measurements should to beused calculate doses. Regimens -42- 2Kaletra® (Lopinavir/Ritonavir) <2 -< Raltegravir (Isentress®) <6 2- 6-9 0 Raltegravir (Isentress®) + 10+ g yas Preferred PEP Age (years) Zidovudine (Retrovir®) + (Epivir®) Lamivudine + Zidovudine (Retrovir®) + (Epivir®) Lamivudine + Zidovudine (Retrovir®) + (Epivir®) Lamivudine + Raltegravir (Isentress®) + TDF +Lamivudine appropriate ofraltegravir dosing recommend ageandweight NB ifunder35KG, wewould 300mg (TDF) / tenofovir disoproxil fumarate Truvada® (emtrictabine 200mg 10 (see dosing dosing (see Table 2below) (Epivir®) + TenofovirLamivudine + TDF Kaletra® (Lopinavir/Ritonavir) Raltegravir (Isentress®) or 2. Zidovudine (Retrovir®) + (Epivir®) Lamivudine + Kaletra® (Lopinavir/Ritonavir) 1. Lamivudine (Epivir®) Lamivudine + Tenofovir+ (Viread®) TDF Kaletra® (Lopinavir/Ritonavir) Raltegravir (Isentress®) or 2. Zidovudine (Retrovir®) + (Epivir®) Lamivudine + Kaletra® (lopinavir/Ritonavir) 1. tablet 300mg (Combivir®) combined 150mg/ZidovudineLamividune Raltegravir (Isentress®) + 1. Alternative PEP Liquid formulations chewable tablets) when available Use Raltegravir (Isentress® preparations available below) to the tablets table (See of raltegravir isnot bioequivalent the chewable formulation of for children >25Kg. Note Adult of Raltegravir dose with renal insufficiency alternative for Tenofovir inthose As peradult guidelinewithan Notes
toolkit Generally, are medicines welltolerated withtheexception ofminor, initialgastrointestinal disturbance andpossible headache. iscorrectDosing asperdate ofguidelinepublication butfor updated CHIVA see dosing ART table dosing http://www.chiva.org.uk/ Table andSideEffects 6:HIVPEPDrugs,Doses cautions for use. *This list ofsideeffects isnot exhaustive –refer to product datasheet for detailed information onsideeffects, interactions andother with other medicines swallow tablets children >25Kg whocannot tablets for children 11-25Kg and bioequivalent; usechewable Note: Formulations are not (Isentress®) Raltegravir (RAL) Drug (Retrovir®) Zidovudine (AZT, ZDV) (Epivir®) (3TC) Lamivudine impairment not useifknownrenal Do Truvada® All doses expressed as All expressed doses TDF 245mg Tenofovir disoproxil (TD) = disoproxil fumarate (TDF) 300mg TenofovirNote: (Viread®) Tenofovir TDF All as expressed does TDF(TD) Tenofovir disoproxil (TD) disoproxil fumarate =245mg 300mg TenofovirNote: (Viread®) Tenofovir TDF Continued: Combivir® Lopinavir (LPV) on are based All doses tablets =5mLofliquid 2 adult tablets =4paediatric Kaletra®
toolkit Appendix 7 HIV Post-exposure prophylaxis (PEP) 7HIVPost-exposure (updated -Appendix EMI Guidelines June2018) swallowed) 100mg (can or bechewed Chewable Tablet: 25mg, Tablet: 400mg Formulation Liquid:10mg/mL Capsule:100mg Liquid:10mg/mL Tablet: 150mg Emtricitabine FTC 200mg) (Tenofovir TDF 300mg/ Combined tablet: water within5minutes in10mL disperses (245mg) the tablet: TDF (TD) 300mg For paediatric use: 300mg (245mg) Tablet(TD) TDF water within5minutes in10mL disperses (245mg) the tablet: TDF (TD) 300mg For paediatric use: 300mg (245mg) Tablet:(TD) TDF Zidovudine (ZDV) 300mg Zidovudine (ZDV) / 150mg(3TC) Lamivudine Combined tablet: Ritonavir (RTV) 50mg Ritonavir (RTV) Lopinavir (LPV)200mg/ (yellow) Adult tablet: 25mg Ritonavir (RTV) Lopinavir (LPV)100mg/ (pale yellow) Paediatric tablet: 20mg permL Ritonavir (RTV) 80mg/ Lopinavir (LPV) Liquid: 10 Take withorwithoutfood. >40Kg: 300mgBD 28-40Kg: 200mg BD 20-28Kg: 150mgBD 14-20Kg: 100mgBD 11-14Kg: 75mgBD Chewable Tablet: From 25Kg 400mgBD Tablet: Dose nausea occurscan betaken withfood. Preferably stomach. onanempty If incombinationwhen used products) of250mgBD(max.dose 300mgBD 180mg/m²/Dose BDto amaximum Capsule orliquid: Take withorwithoutfood. 150mg BD 4mg/Kg/dose BDto amaximumof Tablet orLiquid: >35Kg: 1tablet daily Combined tablet: 14-17Kg:120mg(99mg)= 4mL 12-14Kg: 100mg(83mg)= 3.4mL 10-12Kg: 80mg(66mg)= 2.7mL 8mg (6.5mg)/Kg oncedaily 2-12 years: >35Kg: 1tablet daily Tablet: to improve taste canThe dose bediluted inorange juice ≥35Kg: 300mg(245mg)= 10mL 34-35Kg: 9.4mL 280mg(231mg)= 32-34Kg: 8.8mL 260mg(215mg)= 29-32Kg: 240mg(198mg)=8.1mL 27-29Kg: 7.4mL 220mg(182mg)= 24-27Kg: 6.7mL 200mg(165mg)= 22-24Kg: 6.1mL 180mg(149mg)= 19-22Kg:160mg(132mg)= 5.4mL 17-19Kg:140mg(116mg)= 4.7mL Continued: >30Kg: 1tablet daily twice Combined tablet: >35Kg: 2 Tablets BD Adult tablet: >35Kg: 4 Tablets BD 25-35Kg: 3 Tablets BD 15-25Kg: 2tablets BD Paediatric tablet: xBSA inmls=(300 Dose 300mg/m²/dose BD Liquid: ) /80 Rash, nausea, hepatitis Potential SideEffects neuropathy myopathy, hepatitis, anaemia, nausea, headache, Granulocytopenia and/or nausea, diarrhoea, headache Peripheral neuropathy, demineralization tubular, dysfunction bone vomiting, diarrhoea, renal Headache nausea, impairment notDo useifknownrenal impairment notDo useifknownrenal As for ZDV and3TC nausea, vomiting, headache Diarrhoea, abdominalpain, * -43- Appendix 7 HIV Post-exposure prophylaxis (PEP) 7HIVPost-exposure (updated -Appendix EMI Guidelines June2018) References -44- 10. 8. 6. 5. 4. 3. 2. 1. 9. 7.
Med Sci 2005;174(2):14-20 Sci Med a retrospective ofscreening, prevalence, cross-sectional survey incidenceandhepatitis Bimmunisation uptake. IrJ Gr L ReportsonAntenatalHIVTestinginIreland/File,15285,en.pdf programme, 2008 to 2014. August 2015. http://www.hpsc.ie/A-Z/HIVSTIs/HIVandAIDS/AntenatalHIVTesting/ He MISI 2 inhealthcareviruses workers. November 2008. and Health Protection ofsignificantexposure occupational to bloodborne Eye Scotland. of theneedle. Surveillance He Journal ofSTD & AIDS. 2016 Apr 19. pii:0956462416641813. [Epub ahead ofprint]. UKguidelinefor theuseofHIVPost-Exposure Prophylaxis Following Exposure, 2015. Sexual International M. C h Group on AIDS. Department ofHealth,Advisory London: September2008. D Group. 1997;337:1485-90. NEngl JMed Needlestick Surveillance seroconversion inhealth care workers after percutaneous exposure. Centers for Disease Control andPrevention C L 2001;323:1209-13. B, hepatitis and HIV andriskfactors C, inentrants to Irishprisons:anational cross survey. sectional BMJ Centre, 2016.
h potentially to blood-borne exposed CHIVA viruses. Childrens HIV June2015.Association Guidelines, F ong J, J, ReaperAllwright Reynolds S,Barry S, BradleyThornton F, L, et al.Prevalence to ofantibodies hepatitis andovitz RJ, Currier JS.Postexposure prophylaxis for HIVinfection. 2009;361:1768-75. NEngl JMed ttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_088185 ardo DM, Culver DH, Ciesielski CA, Srivastavaardo DM,Culver PU, CA, DH,Ciesielski Marcus R, Abiteboul D, et al. A case-control study ofHIV resswell F, Waters Fox BriggsE, J, Harbottle L, J, HawkinsD, Murchie M,Radcliffe Rafferty K, P, Rodger Fisher A, epartment ofHealth. HIVpost-exposure prophylaxis: GuidancefromExpert Officers’ Medical theUKChief oster C, Tudor-Williams Bamford G, Post-Exposure A. Prophylaxis for (PEP) Guidelines children andadolescents ttp://www.chiva.org.uk/files/2814/3575/6995/CHIVA_PEP_2015_final.pdf ogan L, ogan L, B,KeenanTiernan N,Smyth M,Geoghegan E.Bloodborne virusinfections amongdrugusersinIreland: alth Centre. Protection Surveillance Voluntary antenatal HIVtesting inIreland: Results ofthescreening alth Protection Agency Centre for for Infections, Wales, National Public Health Service CDSCNorthernIreland 015: findings from themenwhohave withmeninternet sex survey. Dublin:Health protection Surveillance
toolkit