UK changes PEP meds: raltegravir replaces PIs

The UK has dropped the use of protease inhibitors (PIs) in combinations for Post Exposure Prophylaxis (PEP). This refers to when an HIV negative person uses HIV drugs for one month immediately after a risk for HIV – usually a missed or broken condom.

The switch to raltegravir as the third active drug in PEP should make it much easier to tolerate. A combination with fewer side effects has the potential to increase the number of people who come forward to use PEP.

It could also increase the number of people who complete the monthly course of PEP as drop out rates are generally high.

Raltegravir is more rapidly absorbed, compared to PIs, and this may improve the chance that PEP is effective at stopping potential HIV infections.

Prescribing guidelines are also being updated to say the PEP is no longer indicated if the HIV positive partner has an undetectable viral load.

This recommendation reflects the dramatic impact HIV treatment has on reducing the risk of transmission. Results from the PARTNER study reported no linked transmissions between sero-different partners after more than 44,500 times when sex occurred without using condoms.

See this report from CROI for more details of this important study:
i-base.info/htb/24904

Although some clinics have already switched to the new combination a few centres may continue with existing stocks (using Kaletra). This should only be for a short period.