HIV and ID Observations

February 25th, 2018

Is Self-Administered Postexposure Prophylaxis Another Viable Option for HIV Prevention?

Most of the pivotal trials of pre-exposure prophylaxis (PrEP) have used daily therapy. The lone exception is the IPERGAY study. Men at high risk for acquiring HIV took two tablets of tenofovir DF/emtricitabine (TDF/FTC, Truvada) before sex, and one tablet the next 2 days. The strategy was highly effective in preventing HIV acquisition, and intermittent PrEP is endorsed […]

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August 23rd, 2015

Post-Exposure Prophylaxis for HCV Can’t Be Cost-Effective — But We Might End Up Recommending It Anyway

An email query from a colleague: Hi Paul, Just got a call from one of our surgeons who got a needlestick from a suture needle, small amount of blood. Patient is HCV +. Any post-exposure prophylaxis recommended? Thanks, Dan The quick answer is no, it’s not recommended. From the guidelines: But it’s a natural question to ask for several reasons — […]

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August 7th, 2013

Occupational Post-Exposure Prophylaxis (PEP) Guidelines Updated — And They Are Clear and Sensible

Good news here — the United States Public Health Service has issued new national guidelines for management of occupational exposure to HIV. Authored by an expert panel, these updated occupational PEP guidelines replace the (woefully outdated, sorry, had to write that) previous version, which dates back to 2005. On a quick read-through, despite the density of print, the […]

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April 20th, 2013

Postexposure Prophylaxis (PEP) After Blast Injuries

From a colleague came this query: We are being consulted by surgeons who are finding within blast victims tissues from other humans. We have been offering post-exposure prophylaxis. Have you folks developed any policies re PEP for explosion victims? Welcome your thoughts, P Needless to say, the bombing victims are currently facing far greater challenges than […]

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March 1st, 2012

Post-Exposure Prophylaxis, the World’s Most Outdated HIV Guidelines, and What To Do About Them

Every time I cover HIV prevention in a lecture, it’s always kind of embarrassing to cite the “official” post-exposure prophylaxis (PEP) guidelines, which are here (non-occupational) and here (occupational). That’s right, they were last updated in 2005, the year of Hurricane Katrina. Yes — more than six years ago. The alternative choices seem particularly curious (read: don’t do […]

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February 1st, 2009

Whither PEPFAR?

Mark Dybul will no longer be running the President’s Emergency Plan for AIDS Relief, or PEPFAR, the multi-billion dollar international program for HIV treatment program started by Bush in 2003. Some are happy.  Others are not. (Note the exquisite use of euphemism — he was “required to submit his resignation“, not “fired.”) Experts on global HIV treatment […]

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October 21st, 2008

Back to School, Day 4: PEP and More PEP

After a lecture on HIV for Primary Care Providers in our course last week, the most controversial topic was, not surprisingly, the use of post-exposure prophylaxis (PEP) for both occupational and non-occupational exposures.  And today, after an entire lecture on PEP to a group of HIV providers in our AIDS course, again the subject drew […]

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October 18th, 2008

Back to School, Day 2

During the course, often the best questions and anecdotes come during the breaks.  Here are a few: Tons of questions about our favorite nemesis, MRSA.  What works for chronic carriers?  How do you manage family members who you suspect would be culture-positive (and the source of recurrences), but are not your patient?  What if the vet […]

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