Expert Advocates for Integrating Updated CDC nPEP Guidelines into Routine Medical Practice

A recent commentary published in the Annals of Internal Medicine by Dr. Roy Gulick, Chief of Infectious Diseases at Weill Cornell Medicine, emphasizes the significance of the revised CDC HIV Non-Occupational Post-Exposure Prophylaxis (nPEP) guidelines. These updated guidelines, last revised in 2016, incorporate recent advances in HIV prevention and are designed to be practical for everyday medical use. Dr. Gulick argues that making nPEP guidelines a standard part of general medical practice can substantially reduce the occurrence of new HIV infections and improve public health outcomes.

The 2025 update introduces several key changes to enhance the effectiveness and accessibility of nPEP. Notably, the window for initiating nPEP has been shortened from 72 hours to within 24 hours of potential exposure, emphasizing the urgency of timely treatment. The recommended regimens now favor a simplified three-drug combination: an HIV integrase inhibitor—either bictegravir or dolutegravir—paired with two nucleoside reverse transcriptase inhibitors, such as tenofovir (either alafenamide or disoproxil fumarate) combined with emtricitabine or lamivudine.

Assessment of exposure risk has been expanded to include factors like the HIV RNA level of the source individual and whether the exposed person is on PrEP, aiding clinicians in making more precise decisions. Diagnostic testing protocols now recommend immediate HIV testing using rapid or combination antigen-antibody tests, with particular attention to individuals who have taken injectable long-acting PrEP, for which an RNA test is advised.

Furthermore, the CDC guidelines now incorporate comprehensive guidance for healthcare providers on implementing nPEP and exploring strategies like 'PEP to PrEP' for ongoing prevention in at-risk populations. These developments aim to streamline HIV prevention efforts, making nPEP more accessible and effective as part of routine healthcare.

For more information, the detailed analysis can be found in Dr. Gulick’s article in the Annals of Internal Medicine (2025). The updated guidelines are poised to become an essential part of medical practice, significantly contributing to the fight against HIV.

source: https://medicalxpress.com/news/2025-05-cdc-npep-guidelines-general-medical.html