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Who Is the Source of HIV Exposure in the San Francisco Post-Exposure Prevention (PEP) Project? M. E. ROLAND1*, J. N. MARTIN2, R. M. GRANT1, J. D. BAMBERGER3, T. J. COATES2, M. H. KATZ3, and J. O. KAHN1.
1Univ. of California Positive Hlth. Program at San Francisco Gen. Hosp; 2Ctr. for AIDS Prevention Studies; and 3San Francisco Dept. of Publ. Hlth Introduction: 401 index subjects enrolled in the San Francisco PEP Project within 72 hours of a potential high risk sexual or injection drug use exposure to HIV. They received HIV testing, counseling and were offered 28 days of antiviral medications. The source of exposure was evaluated for HIV antibody status, CD4+ T-cell count, HIV-1 RNA level, antiretroviral (ARV) history and drug resistance.
Results: 66 indexes recruited 68 source subjects. There were no significant differences in age, ethnicity, or risk behavior of indexes who did and did not recruit their source. More women recruited sources (34% vs 15%; p=0.02). 31% of indexes who knew their source was HIV positive, vs 6 -12% whose source HIV status was unknown, recruited sources. 52 sources tested HIV antibody positive. HIV-1 RNA (copies/mL) bDNA (Bayer Quantiplex v.2.0 or 3.0): 40% were undetectable (<50/500 = LOD), 31% had LOD -10,000; 12% had 10,001-30,000; 10% had 30,001-60,000; and 8% had >60,000. CD4+ T-cell count (cells/mL): 29% had <200, 38% had 200 - 500, and 29% had >500. ARV History:79% had ever used any ARV, 71% any protease inhibitor (PI) and 23% any non-nucleoside reverse transcriptase inhibitor(NNRTI). Current ARV Use: 69% were using any ARV, 60% any PI, and 17% any NNRTI. Nucleoside Analogue (NRTI) Use: 62% ever used AZT (21% current); 73% ever used 3TC (48% curr.), 56% ever used D4T (40% curr.); 35% ever used ddI (13% curr.).
Resistance: Genotyping was completed on 16 specimens. Reverse Transcriptase mutations were seen in 10/16, with the number of positive specimens in parentheses: M41L (4), D67L (4), L210W (3), T215Y(5); >/= 3 AZT mutations (3); M184V (7). No NNRTI mutations were seen. Primary Protease (PR) mutations were seen in 6/16, with the number of positive specimens in parentheses: M46I (3), I54V (1), V82A (3), L90M (5). Secondary PR mutations were seen in 15/16.
Discussion: Exposed individuals seeking PEP who knew their source was HIV positive were more likely to bring that person in for testing than those who did not know the source's HIV status. 40% of sources had an undetectable plasma HIV-1 RNA level. HIV positive source subjects were highly ARV experienced, and a significant proportion of treated individuals had resistance mutations to AZT and 3TC, ARVs commonly used for PEP.
Key Words: antiretroviral, Post-Exposure Proph., resistance
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