Incomplete adherence

Intolerable side-effects result in many clients failing to complete the prescribed course of NPEP. In a meta-analysis of PEP adherence, completion rates were 57% overall and 67% in MSM.[16] Toxicity driven discontinuation was commoner with three-drug regimens than with two-drug regimens (2% vs 9% respectively).[17] The World Health Organization (WHO) recommends that three antiretroviral drugs be universally used.


 Given that between one half and one third of clients do not complete the prescribed course principally because of side-effects, the choice of safe, tolerable drugs for use in NPEP is paramount and nurses have an important role in supporting clients on PEP who experience side-effects (see Table 12). In Australia, Truvada (emtricitabine and tenofovir disoproxil fumarate) with the integrase inhibitor raltegravir is widely used as three-drug NPEP. In men who have sex with men, it has been shown to be well tolerated with high rates of on-drug adherence, treatment completion and, were a protease inhibitor the third drug, a low risk of potentially dangerous drug reactions.[19] More recently, Truvada with the non-nucleoside reverse transcriptase inhibitor (NNRTI) rilpivirine and Truvada with the integrase inhibitor dolutegravir have both been evaluated as three-drug HIV postexposure prophylaxis in men who have sex with men; both have also demonstrated low toxicity, high adherence, high completion rates and the added convenience of once-daily dosing.[20] [21]