Morbidity and Mortality Weekly Report: Recommendations and Reports, May 8, 2025 / Vol. 74 / No. RR-1

Details

• Alternative Title:
  Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV — CDC Recommendations, United States, 2025
• Journal Article:
  Morbidity and Mortality Weekly Report (MMWR): Recommendations and Reports
• Personal Author:
  Tanner, Mary R. ; O’Shea, Jesse G. ; Byrd, Katrina M. ; Johnston, Marie ; Dumitru, Gema G. ; Le, John N. ; Lale, Allison ; Byrd, Kathy K. ; Cholli, Preetam ; Kamitani, Emiko ; Zhu, Weiming ; Hoover, Karen W. ; Kourtis, Athena P.
• Corporate Authors:
  National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (U.S.)
• Description:
  Nonoccupational postexposure prophylaxis (nPEP) for HIV is recommended when a nonoccupational (e.g., sexual, needle, or other) exposure to nonintact skin or mucous membranes that presents a substantial risk for HIV transmission has occurred, and the source has HIV without sustained viral suppression or their viral suppression information is not known. A rapid HIV test (also referred to as point-of-care) or laboratory-based antigen/antibody combination HIV test is recommended before nPEP initiation. Health care professionals should ensure the first dose of nPEP is provided as soon as possible, and ideally within 24 hours, but no later than 72 hours after exposure. The initial nPEP dose should not be delayed due to pending results of any laboratory-based testing, and the recommended length of nPEP course is 28 days.
  
  The recommendations in these guidelines update the 2016 nPEP guidelines ( CDC. Updated guidelines for antiretroviral postexposure prophylaxis after sexual, injection drug use, or other nonoccupational exposure to HIV — United States, 2016. Atlanta, GA: US Department of Health and Human Services, CDC; 2017 ). These 2025 nPEP guidelines update recommendations and considerations for use of HIV nPEP in the United States to include newer antiretroviral (ARV) agents, updated nPEP indication considerations, and emerging nPEP implementation strategies. The guidelines also include considerations for testing and nPEP regimens for persons exposed who have received long-acting injectable ARVs in the past. Lastly, testing recommendations for persons who experienced sexual assault were updated to align with the most recent CDC sexually transmitted infection treatment guidelines.
  
  These guidelines are divided into two sections: Recommendations and CDC Guidance. The preferred regimens for most adults and adolescents are now bictegravir/emtricitabine/tenofovir alafenamide or dolutegravir plus (tenofovir alafenamide or tenofovir disoproxil fumarate) plus (emtricitabine or lamivudine). However, the regimen can be tailored to the clinical circumstances. Medical follow-up for persons prescribed nPEP also should be tailored to the clinical situation; recommended follow-up includes a visit at 24 hours (remote or in person) with a medical provider, and clinical follow-up 4–6 weeks and 12 weeks after exposure for laboratory testing. Persons initiating nPEP should be informed that pre-exposure prophylaxis for HIV (PrEP) can reduce their risk for acquiring HIV if they will have repeat or continuing exposure to HIV after the end of the nPEP course. Health care professionals should offer PrEP options to persons with ongoing indications for PrEP and create an nPEP-to-PrEP transition plan for persons who accept PrEP.
  
  The record also serves as the landing page for the Required Web Postings related to this resource. The Required Web Posting can be located in Supporting Files section of this record. The Required Web Postings include the following: 1) "Peer Review Plan for the Draft “Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV—United States, 2024 Update”; and, 2) CDC Response to Peer Review of the Draft: Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV, United States, 2025 Update.
  
  For more information on the CDC/ATSDR Peer Review Agenda, see https://www.cdc.gov/science-quality/php/information-quality-support/cdc-atsdr-peer-review-agenda.html
  
  
• Subjects:
  HIV Infections / Prevention & Control Humans Post-Exposure Prophylaxis Substance Abuse, Intravenous / Complications
• Keywords:
  nPeP
• Source:
  Morbidity and Mortality Weekly Report (MMWR): Recommendations and Reports, 2025; v. 74, no. 1
• Series:
  Recommendations and Reports: Morbidity and Mortality Weekly Report (MMWR)
• ISSN:
  1057-5987 (print) ; 1545-8601 (digital)
• Document Type:
  Journal Issue
• Genre:
  Tables ; Statistics ; Guideline ; Peer Review Plan
• Place as Subject:
  United States
• Location:
  North America
• Pages in Document:
  59 pdf pages
• Volume:
  74
• Issue:
  1
• Peer Reviewed:
  True
• Collection(s):
  Guidelines and Recommendations Morbidity and Mortality Weekly Report (MMWR)
• Main Document Checksum:
  urn:sha-512:7f03ef9f408fb89c653ae0dbfd0c2a2acf2d96eb8fc243114ec7c5ab92cde2bc93253c3b2b189fa70be277c7f3ec507a28a3b00fb23a7f515fb151bf03f2dc5e
• Download URL:
  https://stacks.cdc.gov/view/cdc/177225/cdc_177225_DS1.pdf
• File Type:
  [PDF - 1.14 MB ]