Page 245 - ATP-P 11th Ed

3. Consult with unit medical officer ASAP to discuss the case and obtain further guidance
after any significant exposure.
a. If the Rapid HIV Test is positive, initiate PEP.
b. If high-risk exposure occurs and a Rapid HIV Test is unavailable, initiate PEP.
c. If a Rapid HIV Test is negative, seek medical officer guidance to determine the need
for PEP.
4. Initiate antiretroviral triple therapy according to the following priority of drugs.
Choose only 1 of the following drug treatment options.
a. Atripla (emtricitabine/tenofovir/efavirenz), 1 PO daily
®
i. 52% incidence of CNS side-effects SECTION 2
ii. Known to cause birth defects. Category D drug. Be sure that a female
patient has a negative pregnancy test prior to administration of emtricitabine/
®
tenofovir/efavirenz (Atripla ).
®
b. OR Combivir (lamivudine and zidovudine) 1 tablet PO bid AND teno fovir
®
( Viread ) 300mg PO daily
®
c. OR Truvada (emtricitabine/tenofovir) 1 PO daily AND Kaletra (lopinavir/ritona-
®
vir) 4 pills PO daily, taken simultaneously
®
®
d. OR Truvada (emtricitibine/tenofovir) 1 PO daily AND AZT zidovudine ( Retrovir )
300mg PO bid
i. Possible antagonism with decreased effectiveness.
e. OR lamivudine and zidovudine (Combivir ) 1 tablet PO bid AND nelfinavir (Vira-
®
®
cept ) 1250mg PO bid
i. Older regimen. Replaced by options 4a and 4b.
5. Do not use alcoholic beverages after lamivudine and zidovudine (Combivir )
®
administration.
6. For GI side-effects of medication, treat per Nausea and Vomiting Protocol.
7. Maintain hydration and nutrition status.
Disposition
1. Urgent evacuation if a significant exposure occurs and HAART is not available.
2. Routine evacuation if HAART is available and Rapid HIV Test is positive.
3. Consult unit medical officer to determine the need for, and the priority of evacu-
ation, if high-risk exposure has occurred and a Rapid HIV Test is negative.

234 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 235