While inserting a central line, a medical senior house officer injures herself with a suture needle that had been used to stitch a patient with HIV infection. The injury is sufficient to draw blood. The Patient is 45 yrs old and has been infected with HIV for 11 yrs. He has been compliant with therapy for several years and has recently changed his tablets because of alterations in his appearance. His last CD4 count was 350 cells/mm3. The house officer is offered post exposure prophylaxis.
Which regimen should she take?
A. AZT and lamivudine
B. Tenofovir and emtricitabine
C. AZT, lamivudine, abacavir
D. AZT, lamivudine, DDI
E. AZT, lamivudine, stavudine
Answer:
B--Tenofovir and emtricitabine
Discussion: This is standard post exposure prophylaxis and should be given within the hour. If possible, the patient’s notes should be reviewed to see if he has evidence of resistance to any of the HIV medications. Post exposure prophylaxis can then be tailored appropriately.
Triple nucleoside regimens are not used routinely in this context as they are felt to be less potent in HIV Patients with low CD4 counts than regimens containing (NNRTIs) or (PIs).
Stavudine and AZT/zidovudine are not used together.
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