Background
Post exposure prophylaxis (PEP) is a cornerstone of HIV prevention. The associations TDF/FTC + DTG or RAL is the most used in clinical practice, but the single-drug-regimen BIC/FTC/TAF is increasingly adopted due to its efficacy, resistance barrier and tolerability. Real-world data on its use as PEP are still limited. Furthermore, PEP represents a key strategy for engaging key population for HIV and STI in a prevention continuum, including vaccinations and PrEP.
We present characteristics of people referred for PEP to “D. Cotugno” hospital in Naples, Italy, and describe outcome, tolerability and treatment completion rates using BIC/FTC/TAF.
Methods
At “D. Cotugno” an Emergency Department (ED) is available 24/24 for initial PEP dispensation and “Time 0” serology assessment, then indication for PEP is reassessed in a dedicated service, operating 2 days a week.
We retrospectively analyzed all individuals presenting at “D. Cotugno” Hospital, Naples, after HIV at-risk exposure (March 2023–August 2025). Data included demographics, type of exposure, baseline HIV/STI serologies, PEP prescription and completion, adverse events (AEs), HIV outcomes, PrEP transition, and preventive vaccinations.
Results
A total of 405 individuals referred to ED in the study period, and PEP with BIC/FTC/TAF was started in 381. Among them, PEP was confirmed in 273 persons after reassessment in the dedicated service. Demographic and clinical characteristics are presented in table 1.
The association BIC/FTC/TAF has been used in all 273 confirmed PEP. The 28-day course has been completed in 262 (96%). Among the not 11 completed, 3 were lost-to-follow-up, 3 suspended for HIV-negative test from the source, and 5 for side effects, mainly gastrointestinal symptoms. Among those who completed, 24 (9%) reported self-limited side effects (nausea, gastralgia, diarrhoea, headache, insomnia). A 3-month follow-up was completed in 261: no HIV seroconversion was documented. New syphilis infections emerged in 15 clients.
PEP-to-PrEP continuum was proposed to 161 clients, and 102 (63%) started PrEP. Vaccinations for HAV, HBV, HPV, Mpox were recommended if indicated, though uptake rates are under evaluation.
Conclusions
In this large real-world cohort, BIC/FTC/TAF was highly effective and well tolerated as PEP, with very high completion rate and no HIV infections. Importantly, most among eligible individuals transitioned from PEP to PrEP, highlighting the role of PEP as an entry point into the HIV prevention continuum.