Nonoccupational HIV post-exposure prophylaxis

Nonoccupational HIV post-exposure prophylaxis: a 10-year retrospective analysis.

The authors conducted a retrospective analysis of administration of non-occupational HIV post-exposure prophylaxis in a single centre where tracing and testing of the source of exposure were carried out systematically over a 10-year period. Files of all non-occupational HIV post-exposure prophylaxis requests between 1998 and 2007 were reviewed. Characteristics of the exposed and source patients, the type of exposure, and clinical and serological outcomes were analysed. Request for non-occupational HIV post-exposure prophylaxis increased by 850% over 10 years. Among 910 events, 58% were heterosexual exposures, 15% homosexual exposures, 6% sexual assaults and 20% nonsexual exposures. In 208 events (23%), the source was reported to be HIV positive. In the remaining cases, active source tracing enabled 298 HIV tests to be performed (42%) and identified 11 HIV infections (3.7%). Non-occupational HIV post-exposure prophylaxis was able to be avoided or interrupted in 31% of 910 events when the source tested negative. Of 710 patients who started non-occupational HIV post-exposure prophylaxis, 396 (56%) reported side effects, among whom 39 (5%) had to interrupt treatment. There were two HIV seroconversions, and neither was attributed to non-occupational HIV post-exposure prophylaxis failure. Non-occupational HIV post-exposure prophylaxis requests increased over time. HIV testing of the source person avoided non-occupational HIV post-exposure prophylaxis in 31% of events and was therefore paramount in the management of potential HIV exposures. Furthermore, it allowed active screening of populations potentially at risk for undiagnosed HIV infection, as shown by the increased HIV prevalence in these groups (3.7%) compared with a prevalence of 0.3% in Switzerland as a whole.

Editors’ note: Conducting a randomised controlled trial to determine the efficacy of n-PEP (nonoccupational post-exposure prophylaxis) is not possible for ethical reasons but animal studies, prevention of mother-to-child transmission, and case-control studies after needle stick injuries support a protective effect. This large study conducted in Lausanne, Switzerland over 10 years found that the best way to prevent unnecessary exposure to antiretroviral drugs for 28 days (64% of people reported side effects, treatment costs are charged directly to the patient who gets partially reimbursed through insurance) was to contact the source and encourage them to learn their HIV status. Interestingly, police officers were significantly more likely to be able do this than people who were not police officers (57 vs. 32%; p<0.001).>