Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States -- Recommendations from the U.S. Department of Health and Human Services, MMWR 54 (RR02); 1-20, Jan. 21, 2005

Recommendations addressing administration, risk and effectiveness of antiretrovirals in preventing HIV infection when taken soon after a risky sexual or intravenous exposure. From the Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention; National Institutes of Health; Food and Drug Administration; and the Health Resources and Services Administration. In addition to offering guidance to those experiencing sexual or intravenous exposure to HIV with a real risk of transmission, these guidelines are relevant to policy proposals on testing of sexual assault defendants. In those situations where drug therapy is an option, the guidelines state that treatment should be started immediately after exposure, and is not believed to be effective if initiated more than 72 hours after the exposure. From the recommendations summary: For persons seeking care <72 hours after nonoccupational exposure to blood, genital secretions, or other potentially infectious body fluids of a person known to be HIV infected, when that exposure represents a substantial risk for transmission, a 28-day course of highly active antiretroviral therapy (HAART) is recommended. Antiretroviral medications should be initiated as soon as possible after exposure. For persons seeking care <72 hours after nonoccupational exposure to blood, genital secretions, or other potentially infectious body fluids of a person of unknown HIV status, when such exposure would represent a substantial risk for transmission if the source were HIV infected, no recommendations are made for the use of nPEP. Clinicians should evaluate risks and benefits of nPEP on a case-by-case basis. For persons with exposure histories that represent no substantial risk for HIV transmission or who seek care >72 hours after exposure, DHHS does not recommend the use of nPEP. Clinicians might consider prescribing nPEP for exposures conferring a serious risk for transmission, even if the person seeks care >72 hours after exposure if, in their judgment, the diminished potential benefit of nPEP outweighs the risks for transmission and adverse events. For all exposures, other health risks resulting from the exposure should be considered and prophylaxis administered when indicated. Risk-reduction counseling and indicated intervention services should be provided to reduce the risk for recurrent exposures.