| |
Post-Exposure Prophylaxis after Sexual or Drug Use Exposure to HIV: Final Results from the San Francisco Post-Exposure Prevention (PEP) Project J. N. MARTIN*, M. E. ROLAND, J. D. BAMBERGER, M. A. CHESNEY, C. WALDO, J. UNICK, C. LAY, M. H. KATZ, T. J. COATES, and J. O. KAHN.
Univ. of California, San Francisco and San Francisco Dept. of Publ. Hlth., CA Background: The efficacy of PEP following occupational HIV exposure has prompted advocacy for PEP following sexual or drug use exposure to HIV. To date, however, the feasibility of providing PEP after non-occupational exposures in the community has not been determined.
Methods: A feasibility study was performed of PEP in persons reporting sexual (receptive or insertive anal or vaginal intercourse; or receptive oral intercourse with ejaculation), injection drug use, or other non-occupational exposures to HIV within the past 72 hrs. All were offered 4 weeks of antiretroviral therapy, received risk reduction and medication adherence counseling, and were followed at 1, 2, 4, 26, and 52 weeks post-exposure.
Results: In 16 months, 401 participants were enrolled. Sexual exposure was most common (94%), followed by injection drug use (2%), non-volitional needle stick accidents (2%), dual sex and drug use exposure (1%), and assault (1%). Among sexual exposures, receptive anal intercourse was most common (40%). Condoms were not used in the majority of sexual exposures (64%); condom failure occurred less frequently (36%). Nearly half of participants (41%) knew their exposure source was HIV-infected; 55% were unsure of source serostatus but reported the source had an HIV risk factor and 4% did not know source serostatus or risk factor history. All but 5 persons elected to use antiviral therapy; AZT/3TC combination twice daily was most common (88%). Follow-up was 96%, 87%, 86%, 71%, and 68% at 1, 2, 4, 26 and 52 wks respectively. Subjective toxicity was common (59% reported nausea, headache, or fatigue), but 80% completed 4 wks of therapy. At the mid-point of therapy, among those still taking therapy, 79% reported complete adherence in the prior 4 days. No HIV seroconversion attributable to the initial exposure has occurred.
Conclusion: Providing PEP within 72 hours to persons reporting sexual or other non-occupational exposures to HIV and following such persons for up to one year is feasible. Determining the efficacy of PEP and the most cost-efficient mechanism of delivery represents the next challenge.
Key Words: PEP, post-exposure proph., primary prevention
|
