Academy Exchange

Hello, 
I'm an APRN working in a free-standing pediatric hospital and working to improve/update our hospital guidelines and standard work surrounding our nPEP patients (specifically as it relates to Sexual Assault). 
With dolutegravir recently receiving approval for patients down to 4 weeks of age, does anyone foresee (or currently already practice) that children aged less than 12 years could utilize dolutegravir (instead of raltegravir which is BID or Kaletra which tastes poorly) safety for their 28 day course of nPEP (in conjunction with appropriate NRTI backbone as per the guidelines)?
With kids it is sometimes difficult to be on the cutting edge and these changes sometimes trickle down while we wait for updated guidelines from the CDC, etc. 
Thanks in advance for any help or opinions!

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Diane Petrie, FNP-BC, AAHIVS
Kansas City, MO
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Hi there!

Although it hasn't made it to the guidelines yet, there is an ongoing study using Bictegravir/emtricitabine/tenofovir alafenamide(Biktarvy) for nPep and so far the results are very promising that this is going to be the most convenient option for nPep since it is a STR.  It is also safe and an approved regimen for children (for use in HIV treatment). Not sure how comfortable you feel changing your hospital guidelines to a regimen that hasn't officially made it to the guidelines yet but I know that some places have already implemented this practice due to the ease of use and accessibility via samples and PAPs. Just a thought, would love to hear what others are doing as we have also recently updated our nPep policy (although we don't currently treat peds patients).

https://community.aahivm.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=5462d5d2-5d02-48d2-89ee-51c2395914e8 

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Kristy D. Johnson-Pich DO, AAHIVS
Medical Advocacy and Outreach
(formerly Medical AIDS Outreach of Alabama) 
Dothan, AL
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Original Message:
Sent: 06-23-2020 13:16
From: Diane Petrie
Subject: Pediatric nPEP

Hello, 
I'm an APRN working in a free-standing pediatric hospital and working to improve/update our hospital guidelines and standard work surrounding our nPEP patients (specifically as it relates to Sexual Assault). 
With dolutegravir recently receiving approval for patients down to 4 weeks of age, does anyone foresee (or currently already practice) that children aged less than 12 years could utilize dolutegravir (instead of raltegravir which is BID or Kaletra which tastes poorly) safety for their 28 day course of nPEP (in conjunction with appropriate NRTI backbone as per the guidelines)?
With kids it is sometimes difficult to be on the cutting edge and these changes sometimes trickle down while we wait for updated guidelines from the CDC, etc. 
Thanks in advance for any help or opinions!

------------------------------
Diane Petrie, FNP-BC, AAHIVS
Kansas City, MO
------------------------------