Postexposure Prophylaxis Against Human Immunodeficiency Virus (HIV): New Guidelines From the WHO: A Perspective.

Guidelines for antiretroviral (ARV) prophylaxis following high-risk exposure (postexposure prophylaxis— PEP) to human immunodeficiency virus (HIV) date to 1990, when the US Centers for Disease Control and Prevention (CDC) first considered such recommendations for persons with occupational exposures to HIV [1]. The US Public Health Service also issued recommendations focused on occupational exposures in 1996 [2]; these recommendations have been updated 5 times [3–7]. Prophylaxis after non-occupational exposures to HIV (via sexual contact and sharing of drugusing paraphernalia) was first addressed by the CDC in 1998 [8] and updated in 2005 [9]. The World Health Organization (WHO) first considered PEP in 2007 and included PEP recommendations in the 2013 consolidated guidelines; both documents focused on occupational exposures [10, 11]. The most recently published WHO guidelines on PEP recommend that a PEP regimen be administered as soon as possible within the 72-hour window period after an HIV-related exposure and that whereas a 2-drug antiretroviral regimen is acceptable, a 3-drug regimen is preferred [12]. The most recent WHO guidelines differ from earlier recommendations in that PEP for both occupational and nonoccupational exposures are considered in the same document [12]. This approach is a welcome step in addressing this topic in resource-limited settings (RLS) for two main reasons: (1) WHO HIV treatment recommendations have been successful in the past 2 decades in great part because of their simplified approach, making them practical to communicate and to implement in RLS; this unified approach to PEP is consistent with that approach; and (2) the ARV regimens used for PEP, which have changed greatly over the years, and the procedures for monitoring persons on PEP are the same for both types of exposures; hence it is logical to combine recommendations for occupational and nonoccupational PEP in one document. Development of PEP guidelines has raised important scientific and implementation issues since they were first developed in 1990; these include efficacy of PEP, choice of ARV regimens, and practical issues of implementation, including follow-up of persons taking PEP [1]. These issues are all highly relevant for implementation of PEP in RLS.