Health Services

Occupational Health

Needlesticks/Exposures

Antiviral Medications for High Risk Exposures

Antiviral medications

Additional lab tests will be done if antiviral medications are prescribed. If so, a urine pregnancy test (females only), CBC with differential and platelets, and complete metabolic panel (CMP) is collected before antivirals are initiated. The CBC and CMP are repeated on days 8, 15, and 29 if the antivirals are taken for the full 28 day regimen.

Antiviral medications are capable of decreasing the rate of transmission of HIV by 81% if taken for a full 28 day period. Pregnancy does not preclude the use of antivirals, the employee may wish to call her OB/GYN but CDC recommends the antivirals be taken even if the employee is pregnant to protect the fetus. Often, antivirals are initiated until test results are returned. A negative HIV result from a source patient eliminates the need for antiviral treatment, which may be stopped if already started. It is not recommended to begin antiviral treatment in the case of an exposure with no identifiable source as the antivirals would need to be taken for a full 28 days and no source patient is identifiable for testing.

Combivir, Kaletra and Truvada are antiviral medications used for high risk bloodborne pathogen exposures. Combivir is a nucleoside analogue and combines lamivudine 150mg and zidovudine 300mg. The tablet is taken BID. It is prescribed for suspected high-risk exposures.

Kaletra may be prescribed with Combivir or Truvada for an exposure to a known HIV+ source patient. Kaletra is a protease inhibitor and consists of Lopinavir 200mg and Ritonavir 50mg. Its regimen is 2 tablets BID.

Truvada is now being used instead of Combivir as it seems to be better tolerated and is taken once a day. Truvada consists of Emtricitabine 200mg and Tenofovir 300mg.

Antivirals are well-known for causing side effects of nausea, vomiting, diarrhea, weakness, headache, musculoskeletal pain, insomnia, dizziness, rashes and occasionally pancreatitis. Approximately 50% of individuals taking these medications may have side effects. Anti-emetics or anti-diarrheals may be utilized to manage the side effects. A high water intake while taking antivirals is recommended to decrease side effects.