Post-exposure Starter Pack versus Full 28 Day Prescription for HIV

HIV PEP medication has been helping to greatly reduce the possibility of infection after exposure to HIV. PEP is prescribed for 28 days as a two or a three-drug regimen. It is recommended that PEP therapy starts within 72 hours after HIV exposure. A recently published report compared the efficacy of the 28 day full prescription of PEP versus the practice in which a 3-5 day PEP Starter Pack course is handed over to patients and they are provided with rest of the PEP course at the next visit.

The Starter Pack

PEP Starter Packs are prescribed by some instead of the whole 28-day PEP to

  • help new users get used to the regimen
  • facilitate and encourage adherence
  • evaluate potential toxicity
  • reduce anxiety for worried patients while providing counseling at the same time

About The Paper

This paper is basically a compilation of data available on PEP practices and the outcomes will help inform future World Health Organization (WHO) PEP guidelines.

Two different authors of the paper simultaneously searched online databases for articles, abstracts and conferences available on PEP practices. In case of any disagreement among the two authors a third author helped. Only randomized trials and prospective observational studies were included in the formulation of the results. The reports which did not report PEP duration and had less than 10 individuals with PEP were not included in the study.

The type of HIV exposure, the study population, the number of drugs for PEP and the use of zidovudine / tenofovir along with attendance in follow-up visits were evaluated in the study.


Although the overall result quality of this systemic review were marked to be very low, the results showed that out of the total 3259 titles which were initially selected only 54 studies passed the inclusive criteria. Out of these, 37 studies were about the Starter pack while 17 studies reported results of the full 28 day PEP prescription.

According to the report, Starter packs were usually given for a period of one to 14 days. 47% of the studies done on the Starter pack showed that most were given a 3-day Starter pack.

It is interesting to note that the prescription of a full 28 day PEP was more common among occupational exposure. It was reported that 22.4% of  individuals who were started on the Starter pack PEP refused to complete treatment as compared to the 11.4% receiving full PEP. 6.8% of the subjects receiving Starter pack stopped the medication due to toxicity while failure was 4.2% in people receiving full PEP.  The overall completion rate of PEP was 70% among the people who were prescribed full PEP versus the Starter Pack which was only 53.2%.


In conclusion, it can be inferred that the Starter packs might have some benefits but the overall compliance and adherence is not ideal. Therefore, an early start of full 28 day PEP is recommended.


Ford N et al., Starter Packs Versus Full Prescription of Antiretroviral Drugs for Postexposure Prophylaxis: A systemic Review. Clinical Infectious Diseases, 2015.