Workplace Safety Considerations in Post-Exposure HIV Prophylaxis: A Case Report of Atypical Hypersensitivity in a Healthcare Worker

Post-exposure prophylaxis (PEP) with antiretroviral therapy is highly effective in preventing human immunodeficiency virus transmission but can be complicated by hypersensitivity reactions, particularly when sequential regimen substitution is required due to adverse events. We describe the case of a 58-year-old female physician who developed an acute vulvovaginal hypersensitivity reaction within one hour of initiating bictegravir/emtricitabine/tenofovir alafenamide for occupational PEP, followed by drug-induced hypersensitivity syndrome after substitution with darunavir. The patient completed her prophylactic course and did not seroconvert to human immunodeficiency virus or hepatitis B virus. This progression illustrates two novel points: (1) vulvovaginal mucosal hypersensitivity as an underrecognized phenotype of bictegravir/emtricitabine/tenofovir alafenamide toxicity, and (2) heightened risk of severe reactions with sequential prescribing in patients with prior sulfonamide allergy. The case highlights the value of allergy risk stratification in urgent PEP protocols and underscores an opportunity to strengthen sex-specific safety reporting in antiretroviral research. Integrating these considerations into occupational health practice may help prevent life-threatening adverse events, reduce time away from work, and support healthcare worker well-being and productivity.