Guideline

Guidelines on post-exposure prophylaxis for HIV and the use of co-trimoxazole prophylaxis for HIV-related infections among adults, adolescents and children: recommendations for a public health approach: December 2014 supplement to the 2013 consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection

Year of Publication

2014

Issuing Institution

World Health Organization

Links

WHO IRIS,WHO IRIS

Recommendations

18 included recommendations

A regimen for post-exposure prophylaxis for HIV with two drugs is effective, but three drugs are preferred

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

tenofovir disoproxil fumarate (TDF) + lamivudine (3TC ) or emtricitabine (FTC) is recommended as the preferred backbone regimen for HIV post-exposure prophylaxis

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

zidovudine (AZT) + lamivudine (3TC) is recommended as the preferred backbone regimen for HIV post-exposure prophylaxis for children. Abacavir (ABC) + 3TC or emtricitabine (FTC) + 3TC (or FTC) can be considered as alternative regimens

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

lopinavir/r or atazanavir/r (ATV/r) is recommended as the preferred third drug for HIV post-exposure prophylaxis for adults and adolescents. Where available, RAL, darunavir/r (DRV/r) or efavirenz (EFV) can be considered as alternative options.

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Very low

lopinavir/r is recommended as the preferred third drug for HIV post-exposure prophylaxis for children younger than 10 years. An age-appropriate alternative regimen can be identified among atazanavir/r (ATV/r), RAL, darunavir (DRV), efavirenz (EFV) and nevirapine (NVP)

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

A full 28-day prescription of antiretroviral drugs should be provided for HIV post-exposure prophylaxis following initial risk assessment

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

Enhanced adherence counselling is suggested for all individuals initiating HIV post-exposure prophylaxis

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

Co-trimoxazole prophylaxis is recommended for severe or advanced HIV clinical disease (WHO stage 3 or 4) and/or for a CD4 count ≤350 cells/mm3 .

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

In settings where malaria and/or severe bacterial infections are highly prevalent, cotrimoxazole prophylaxis should be initiated regardless of CD4 cell count or WHO stage

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Co-trimoxazole prophylaxis may be discontinued in adults (including pregnant women) with HIV infection who are clinically stable on antiretroviral therapy, with evidence of immune recovery and viral suppression.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

In settings where malaria and/or severe bacterial infections are highly prevalent, cotrimoxazole prophylaxis should be continued regardless of CD4 cell count or WHO clinical stage.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

Co-trimoxazole prophylaxis is recommended for infants, children, and adolescents with HIV, irrespective of clinical and immune conditions. Priority should be given to all children younger than 5 years old regardless of CD4 cell count or clinical stage and to children with severe or advanced HIV clinical disease (WHO clinical stage 3 or 4) and/ or those with CD4 ≤350 cells/mm3

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

In settings with a high prevalence of malaria and/or severe bacterial infections, co-trimoxazole prophylaxis should be continued until adulthood irrespective of antiretroviral therapy provision.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

In settings with low prevalence for both malaria and bacterial infections, cotrimoxazole prophylaxis may be discontinued for children 5 years of age and older who are clinically stable and/or virally suppressed on antiretroviral therapy for at least 6 months and CD4 >350 cells/mm3

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

Co-trimoxazole prophylaxis is recommended for HIV-exposed infants from 4–6 weeks of age and should be continued until HIV infection has been excluded by an age-appropriate HIV test to establish final diagnosis after complete cessation of breastfeeding.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

lopinavir/r is recommended as the preferred third drug for HIV post-exposure prophylaxis for children younger than 10 years. An age-appropriate alternative regimen can be identified among atazanavir/r (ATV/r), RAL, darunavir (DRV), efavirenz (EFV) and nevirapine (NVP)

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

Routine co-trimoxazole prophylaxis should be administered to all HIV-infected people with active TB disease regardless of CD4 cell counts.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

An age-appropriate alternative regimen can be identified among atazanavir/r (ATV/r), RAL, darunavir (DRV), efavirenz (EFV) and nevirapine (NVP).

Status

Updated