Non-Healthcare Post-Exposure Prophylaxis

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Non-Occupational Post-Exposure Prophylaxis (nPEP) and Cost Considerations

Introduction

• Many medications for treatment and prophylaxis of are brand-name only and can come with a significant

cost for both insured and uninsured patients. Price may be a significant barrier for appropriate treatment and

patient compliance.

a. Patient Assistance Programs (PAP) are valuable resources that may help physicians make therapy

decisions when cost is a significant barrier

b. Not all guideline recommended therapies have patient assistance programs, and newer combination

products designed to improve adherence that do not have FDA-indications for nPEP are being

cost for both insured and uninsured patients. Price may be a significant barrier for appropriate treatment and

patient compliance.

a. Patient Assistance Programs (PAP) are valuable resources that may help physicians make therapy

decisions when cost is a significant barrier

b. Not all guideline recommended therapies have patient assistance programs, and newer combination

products designed to improve adherence that do not have FDA-indications for nPEP are being

considered as alternative therapies, although data to support their use is lacking

Pharmacotherapy

Truvada +

Isentress or Tivicay*

(first-line)

Truvada +

Prezista + Norvir

Stribild

(guideline alternative)

Genvoya

Generic

Combination

tenofovir DF 300mg /

emtricitabine 200mg

+

raltegravir 400mg or

dolutegravir 50mg

tenofovir DF 300mg /

emtricitabine 200mg

+

darunavir 800mg

+

Ritonavir 100mg

tenofovir DF 300mg /

emtricitabine 200mg /

elvitegravir 150mg /

cobicistat 150mg

Tenofovir alafenamide

10mg /

emtricitabine 200mg /

elvitegravir 150mg /

cobicistat 150mg

Mechanism

Nucleoside reverse

transcriptase inhibitor

(x 2) + integrase

Author,

year

Design/ sample

size

Intervention & Comparison

Outcome

Valin

2016

Prospective

cohort

N = 234

Stribild tolerability in PEP

92% of patients completed 28 days of therapy. 60% reported at

least one ADR but were mild to moderate, with only 3 people

switching regimens.

Mayer

2017

Historical Control

Comparison

N =100

Completion rates of daily

Stribild vs. historical

treatment (BID)

71% completed the course in the Stribild group vs. 57% and 39% in

both historical control group regimens. No participants became

HIV infected.

Inciarte

2017

Prospective open

randomized trial

N = 157

Truvada

+

lopinavir/ritonavir or

elvitegravir/cobicistat

The lopinavir/ritonavir group had a higher PEP non-completion

rate (33%), poor adherence (47%), and ADR rate (90%) than the

elvitegravir/cobicstat group (15%, 9% and 49%, respectively). 1

seroconversion was observed in the elvitegravir/cobicstat group

in a patient with multiple high-risk exposures before and after PEP.

Any patient experiencing possible HIV exposure should be evaluated for appropriateness of nPEP

a. Prophylaxis is only recommended if initiated within 72 hours of exposure

b. Rapid Ag/Ab or antibody blood should be tested. Patients should not receive nPEP if HIV status is positive.

c.

All Patients should be treated with a minimum of a 3-drug antiviral regimen if they meet criteria for prophylaxis

Patients’ financial situation should always be considered prior to prescribing therapy to ensure patients will be able to

obtain access to treatment and prophylaxis. Addressing cost concerns prior to discharge may aid in patient compliance,

even if alternative therapies need to be utilized.

CDC. 2016 nPEP Guideline Update.

Mayer KH, et al. J Acqur Immune Defic Syndr. 2017;15:75(5):535-39.

Valin N, et al. BMC Infect Dis. 2016. doi: 10.1186/s12879-016-2056-3.

Inciarte A, et al. J Antimicrob Chemother. 2017;72:2857-61.

Micromedex [Electronic version].Greenwood Village, CO: Truven Health Analytics. Retrieved June 5, 2020, from http://www.micromedexsolutions.com/