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Jin J, Sun R, Mu T, Jiang T, Dai L, Lu H, Ren X, Chen J, Ye J, Sun L, Wu H, Zhang T, Zou H, Su B. Awareness and Use of Post-exposure Prophylaxis for HIV Prevention Among Men Who Have Sex With Men: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 8:783626. [PMID: 35083243 PMCID: PMC8784556 DOI: 10.3389/fmed.2021.783626] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background: The use of post-exposure prophylaxis (PEP) is effective in reducing HIV risk, but it is underused by men who have sex with men (MSM) due to certain psychological and sociostructural factors. This article assessed the awareness and use of PEP among MSM in an effort to increase the visibility and uptake of PEP among at-risk populations. Methods: We conducted a systematic literature search of the PubMed, Web of Science, PsycINFO, and Google Scholar electronic databases. Studies were screened for inclusion, and relevant data were abstracted, assessed for bias, and synthesized. Pooled effect estimates were calculated using random effects meta-analysis, meta-regression and subgroup analysis, and a qualitative review and risk of bias assessment were performed (PROSPERO, CRD42019123815). Results: Twenty eligible studies involving 12,579 MSM were included in the meta-analysis. The pooled estimate of the proportions of MSM who were aware of PEP was modest at 59.9% (95% CI: 50.5~68.7) and that of MSM who previously used PEP was very low at 4.9% (95% CI: 2.4~9.8). PEP awareness showed no clear change over time, while PEP use significantly changed over time. Multiple factors affected awareness, including educational attainment, race/ethnicity, levels of HIV stigma, access to condoms, and so on. Many factors could potentially impede or facilitate the use of PEP, such as income, lack of PEP information, and partnership. Conclusion: We observed that PEP is an underused HIV prevention strategy among MSM and that once MSM become aware of PEP, the majority are willing to use it if they are supported appropriately in terms of a range of individual, social, and structural barriers. Systematic Review Registration: http://www.cdr.york.ac.uk/prospero, PROSPERO [CRD42019123815].
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Affiliation(s)
- Junyan Jin
- Beijing Key Laboratory for HIV/AIDS Research, Sino-French Joint Laboratory for Research on Humoral Immune Response to HIV Infection, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Runsong Sun
- School of Sociology, Beijing Normal University, Beijing, China
| | - Tingting Mu
- Beijing Key Laboratory for HIV/AIDS Research, Sino-French Joint Laboratory for Research on Humoral Immune Response to HIV Infection, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Taiyi Jiang
- Beijing Key Laboratory for HIV/AIDS Research, Sino-French Joint Laboratory for Research on Humoral Immune Response to HIV Infection, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Lili Dai
- Beijing Key Laboratory for HIV/AIDS Research, Sino-French Joint Laboratory for Research on Humoral Immune Response to HIV Infection, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Hongyan Lu
- Institute for AIDS/STD Control and Prevention, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Xianlong Ren
- Institute for AIDS/STD Control and Prevention, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Jing Chen
- Institute for AIDS/STD Control and Prevention, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Jingrong Ye
- Institute for AIDS/STD Control and Prevention, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Lijun Sun
- Beijing Key Laboratory for HIV/AIDS Research, Sino-French Joint Laboratory for Research on Humoral Immune Response to HIV Infection, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Hao Wu
- Beijing Key Laboratory for HIV/AIDS Research, Sino-French Joint Laboratory for Research on Humoral Immune Response to HIV Infection, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Tong Zhang
- Beijing Key Laboratory for HIV/AIDS Research, Sino-French Joint Laboratory for Research on Humoral Immune Response to HIV Infection, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Bin Su
- Beijing Key Laboratory for HIV/AIDS Research, Sino-French Joint Laboratory for Research on Humoral Immune Response to HIV Infection, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
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Tomasik A, Pokorska-Śpiewak M, Marczyńska M. Non-Vertical Exposures to HIV, HBV and HCV Infection in Children and Adolescents-Risk of Infection, Standards of Care and Postexposure Prophylaxis. Pediatr Rep 2021; 13:566-575. [PMID: 34698220 PMCID: PMC8544719 DOI: 10.3390/pediatric13040067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/04/2021] [Accepted: 10/09/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION in the review, we aimed to present current knowledge about the risk of infection, standards of care, and postexposure prophylaxis (PEP) in pediatric patients after non-vertical exposures to HIV, HBV, and HCV infection. MATERIALS AND METHODS the latest available literature and recommendations of Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), European recommendations for the management of HIV and administration of non-occupational PEP, and Polish AIDS Society were reviewed. RESULTS the majority of cases of non-vertical exposure to blood-borne viruses in the pediatric population consist of sexual exposition and injection with unsterilized sharp objects (usually needlestick injuries). The risk HIV, HBV, and HCV transmission depend on several factors, and each exposure should be evaluated individually with consideration of the patient's medical history. It is crucial to start antiretroviral therapy within 48 h from exposure. Treatment is continued for 28 days, and a 3-drugs regiment is recommended in the majority of cases. Decisions on hepatitis B and tetanus PEP are based on a history of vaccination. There is no PEP for hepatitis C infection, follow-up testing aims for early identification of disease and consideration of treatment options. CONCLUSION all children after the non-vertical exposure to HIV, HBV, and HCV infection should be evaluated by the Infectious Disease specialist as soon as possible after the incident and qualified to post-exposure prophylaxis. Systematic diagnostic and follow-up on children after significant needlestick exposure should be maintained. Children after sexual exposure need a multidisciplinary approach. Response to reported event must be rapid and treatment must be comprehensive.
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Affiliation(s)
- Anna Tomasik
- Doctoral School, Medical University of Warsaw, Żwirki i Wigury, 02-091 Warsaw, Poland
- Department of Children’s Infectious Diseases, Medical University of Warsaw, Wolska 37, 01-201 Warsaw, Poland; (M.P.-Ś.); (M.M.)
- Regional Hospital of Infectious Diseases in Warsaw, 01-201 Warsaw, Poland
| | - Maria Pokorska-Śpiewak
- Department of Children’s Infectious Diseases, Medical University of Warsaw, Wolska 37, 01-201 Warsaw, Poland; (M.P.-Ś.); (M.M.)
- Regional Hospital of Infectious Diseases in Warsaw, 01-201 Warsaw, Poland
| | - Magdalena Marczyńska
- Department of Children’s Infectious Diseases, Medical University of Warsaw, Wolska 37, 01-201 Warsaw, Poland; (M.P.-Ś.); (M.M.)
- Regional Hospital of Infectious Diseases in Warsaw, 01-201 Warsaw, Poland
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Moore DL. Les blessures par piqûre d’aiguille dans un lieu public. Paediatr Child Health 2018. [DOI: 10.1093/pch/pxy130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Dorothy L Moore
- Société canadienne de pédiatrie, comité des maladies infectieuses et d’immunisation, Ottawa (Ontario)
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Abstract
When children sustain injuries from needles discarded in public places, concerns arise about possible exposure to blood-borne viruses. The risk of infection is low, but assessment, counselling, and follow-up of the injured child are needed. This statement reviews the literature concerning blood-borne viral infections after injuries from needles discarded in the community, and provides recommendations for the prevention and management of such incidents.
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Affiliation(s)
- Dorothy L Moore
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario
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Prescription of Postexposure Prophylaxis for HIV-1 in the Emergency Room: Correct Transmission Risk Assessment Remains Challenging. J Acquir Immune Defic Syndr 2017; 74:359-366. [PMID: 27906766 DOI: 10.1097/qai.0000000000001265] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Limited data are available about the accuracy of postexposure prophylaxis (PEP) prescription in the emergency rooms. Here, we evaluated PEP prescription decision making with respect to the risk of sexual HIV transmission and the exposed person's fear vis-à-vis HIV. METHODS Using a risk assessment algorithm, we retrospectively evaluated the adequacy of PEP prescription for all persons presenting at the emergency room of the University Hospital Zurich after consensual sex from 2007 to 2013. We used logistic regression to identify factors that correlate with risk-concordant and risk-discordant decisions. RESULTS We documented 975 persons with a total of 1051 visits for PEP: 83% were men, 71% were Swiss, and 37% were men who have sex with men. In 74% of visits, the decisions were concordant with the risk evaluation algorithm (22% discordant, 4% unknown). In 61% (644/1051) PEP was prescribed; however, in 12% (76/644) the prescriptions were without indication of HIV transmission risk and were attributed to the exposed person's request. Importantly, in 10% (101/1051) of all visits, there were potential risks but PEP was not prescribed, either because of physician's decision or exposed person's refusal. The presence of the source partner strongly correlated with appropriately withholding PEP (adjusted odds ratio for giving PEP 0.05; 95% confidence interval: 0.03 to 0.08). CONCLUSIONS We found that 22% of PEP decisions were risk discordant because of exposed person's request, incorrect estimation of the sexual transmission risk by the physician, or exposed person's refusal to accept PEP. Emergency physicians may benefit from specialized risk assessment training and patients from education in HIV transmission risk awareness.
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Garcia de Olalla P, Molas E, Barberà MJ, Martín S, Arellano E, Gosch M, Saladie P, Carbonell T, Knobel H, Diez E, Caylà JA. Effectiveness of a pilot partner notification program for new HIV cases in Barcelona, Spain. PLoS One 2015; 10:e0121536. [PMID: 25849451 PMCID: PMC4388637 DOI: 10.1371/journal.pone.0121536] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 02/03/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND An estimated 30% of HIV cases in the European Union are not aware of their serological status. This study aimed to assess the effectiveness of a pilot HIV partner notification program. METHODS HIV cases diagnosed between January 2012 and June 2013 at two healthcare settings in Barcelona were invited to participate in a prospective survey. We identified process and outcome measures to evaluate this partner notification program, including the number of partners identified per interviewed index case, the proportion of partners tested for HIV as a result of the partner notification, and the proportion of new HIV diagnoses among their sex or needle-sharing partners. RESULTS Of the 125 index cases contacted, 108 (86.4%) agreed to provide information about partners. A total of 199 sexual partners were identified (1.8 partners per interviewed index case). HIV outcome was already known for 58 partners (70.7% were known to be HIV-positive), 141 partners were tested as result of partner notification, and 26 were newly diagnosed with HIV. The case-finding effectiveness of the program was 18.4%. CONCLUSION This pilot program provides evidence of the effectiveness of a partner notification program implemented in healthcare settings. This active partner notification program was feasible, acceptable to the user, and identified a high proportion of HIV-infected patients previously unaware of their status.
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Affiliation(s)
- Patricia Garcia de Olalla
- EpidemiologyService,Agència de Salut Pública de Barcelona, Barcelona, Spain
- Biomedical Research Consortium of the Epidemiology and Public Health Network (CIBERESP), Barcelona, Spain
- * E-mail:
| | - Ema Molas
- EpidemiologyService,Agència de Salut Pública de Barcelona, Barcelona, Spain
- Internal Medicine-InfectiousDiseases,University Hospital del Mar, Barcelona, Spain
| | - María Jesús Barberà
- Sexually Transmitted Infections Unit, University Hospital Valld’Hebron, Barcelona, Spain
| | - Silvia Martín
- Preventive Interventions and Programs Service,Agència de SalutPública de Barcelona, Barcelona, Spain
| | - Encarnació Arellano
- Sexually Transmitted Infections Unit, University Hospital Valld’Hebron, Barcelona, Spain
| | - Mercè Gosch
- Sexually Transmitted Infections Unit, University Hospital Valld’Hebron, Barcelona, Spain
| | - Pilar Saladie
- Sexually Transmitted Infections Unit, University Hospital Valld’Hebron, Barcelona, Spain
| | - Teresa Carbonell
- Internal Medicine-InfectiousDiseases,University Hospital del Mar, Barcelona, Spain
| | - Hernando Knobel
- Internal Medicine-InfectiousDiseases,University Hospital del Mar, Barcelona, Spain
| | - Elia Diez
- Preventive Interventions and Programs Service,Agència de SalutPública de Barcelona, Barcelona, Spain
- Biomedical Research Consortium of the Epidemiology and Public Health Network (CIBERESP), Barcelona, Spain
| | - Joan A Caylà
- EpidemiologyService,Agència de Salut Pública de Barcelona, Barcelona, Spain
- Biomedical Research Consortium of the Epidemiology and Public Health Network (CIBERESP), Barcelona, Spain
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Additional gonorrhea and Chlamydia infections found with rapid follow-up screening in men who have sex with men with an indication for HIV postexposure prophylaxis. Sex Transm Dis 2015; 41:515-7. [PMID: 25013982 DOI: 10.1097/olq.0000000000000151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sexually transmitted infection was found in 16.5% of the men who have sex with men with a postexposure prophylaxis indication. Chlamydia and gonorrhea screening was repeated after 14 days. Among those who were initially sexually transmitted infection negative, 4.1% had chlamydia or gonorrhea. In postexposure prophylaxis-indicated men who have sex with men, repeat chlamydia and gonorrhea screening is advised to diagnose infections not apparent at baseline screening.
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Cohen SE, Liu AY, Bernstein KT, Philip S. Preparing for HIV pre-exposure prophylaxis: lessons learned from post-exposure prophylaxis. Am J Prev Med 2013; 44:S80-5. [PMID: 23253767 PMCID: PMC3733170 DOI: 10.1016/j.amepre.2012.09.036] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 09/04/2012] [Accepted: 09/19/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Stephanie E Cohen
- STD Prevention and Control, San Francisco Department of Public Health, San Francisco, California 94103, USA.
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Rymer W, Beniowski M, Mularska E. Profilaktyka poekspozycyjna po narażeniu na zakażenie HIV, HBV, HCV – rekomendacje Polskiego Towarzystwa Naukowego AIDS na 2013 r. HIV & AIDS REVIEW 2013. [DOI: 10.1016/s1730-1270(13)70004-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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10
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Preventing human immunodeficiency virus infection among sexual assault survivors in Cape Town, South Africa: an observational study. AIDS Behav 2012; 16:990-8. [PMID: 21301949 PMCID: PMC3337999 DOI: 10.1007/s10461-011-9892-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We describe 131 South African sexual assault survivors offered HIV post-exposure prophylaxis (PEP). While the median days completed was 27 (IQR 27, 28), 34% stopped PEP or missed doses. Controlling for baseline symptoms, PEP was not associated with symptoms (OR = 1.30, 95% CI = 0.66, 2.64). Factors associated with unprotected sex included prior unprotected sex (OR = 6.46, 95% CI = 3.04, 13.74), time since the assault (OR = 1.33, 95% CI = 1.12, 1.57) and age (OR = 1.30, 95% CI = 1.08, 1.57). Trauma counseling was protective (OR = 0.18, 95% CI = 0.05, 0.58). Four instances of seroconversion were observed by 6 months (risk = 3.7%, 95% CI = 1.0, 9.1). Proactive follow-up is necessary to increase the likelihood of PEP completion and address the mental health and HIV risk needs of survivors. Adherence interventions and targeted risk reduction counseling should be provided to minimize HIV acquisition.
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High HIV incidence among MSM prescribed postexposure prophylaxis, 2000-2009: indications for ongoing sexual risk behaviour. AIDS 2012; 26:505-12. [PMID: 22156963 DOI: 10.1097/qad.0b013e32834f32d8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To determine (trends in) HIV incidence among MSM\ who have recently had postexposure prophylaxis (PEP) prescribed in Amsterdam, compared with MSM participating in the Amsterdam Cohort Studies (ACS). DESIGN AND METHODS We used data from MSM who were prescribed PEP in Amsterdam between 2000 and 2009, who were HIV-negative at the time of PEP prescription and had follow-up HIV testing 3 and/or 6 months after PEP prescription (n = 395). For comparison, cohort data from MSM participating in the ACS in the same period were used (n = 782). Poisson log-linear regression analyses were performed to model trends in HIV incidence and identify differences in HIV incidence between both cohorts at different time points. RESULTS Between 2000 and 2009, among MSM who were prescribed PEP, an overall HIV incidence of 6.4 [95% confidence interval (CI) 3.4-11.2] per 100 person-years was found, compared with an HIV incidence of 1.6 (95% CI 1.3-2.1) per 100 person-years among MSM participating in the ACS (P < 0.01). In both cohorts, an increasing trend in HIV incidence over time was observed [incidence rate ratio (IRR(per calendar year)) 1.3 (95% CI 0.9-1.7) and 1.1 (95% CI 1.0-1.2) among MSM prescribed PEP and MSM of the ACS, respectively]. The difference in HIV incidence between both cohorts was most evident in more recent years [IRR(PEP versus ACS in 2009) 4.8 (95% CI 2.0-11.5)]. CONCLUSION Particularly in more recent years, MSM recently prescribed PEP had a higher HIV incidence compared with MSM participating in the ACS, indicating ongoing sexual risk behaviour.
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12
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Pierce AB, Armishaw J, Price B, Wright EJ, Dax EM, Fairley CK, Hoy JF. Nonoccupational post-exposure prophylaxis source tracing: is it really feasible in Australia? HIV Med 2012; 13:436-8. [PMID: 22276852 DOI: 10.1111/j.1468-1293.2011.00986.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A Swiss nonoccupational post-exposure prophylaxis (NPEP) source-tracing study successfully reduced unnecessary NPEP prescriptions by recruiting and testing source partners of unknown HIV serostatus. The Victorian NPEP Service in Australia attempted to replicate this study with the addition of HIV rapid testing and a mobile service. METHODS Patients presenting to two busy NPEP sites who reported a source partner of unknown HIV status were routinely asked if their source could be traced. If the exposed person indicated that their source partner was traceable they were asked to contact them and discuss the possibility of having an HIV test. RESULTS No sources were enrolled and the study was terminated. CONCLUSION We hypothesize that there are a number of differences between Australia and Switzerland that make source tracing unfeasible in Australia.
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Affiliation(s)
- A B Pierce
- Victorian NPEP Service, Infectious Diseases Unit, The Alfred Hospital, Melbourne, Vic, Australia
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13
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García de Olalla P, Caylà JA. [Is it possible to reduce the delay in diagnosing HIV infection?]. Enferm Infecc Microbiol Clin 2011; 28:580-2. [PMID: 20828881 DOI: 10.1016/j.eimc.2010.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 07/21/2010] [Indexed: 10/19/2022]
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Poynten IM, Grulich AE. The emerging role of antiretroviral agents in HIV prevention. Sex Health 2011; 8:137-9. [DOI: 10.1071/sh10117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 09/23/2010] [Indexed: 11/23/2022]
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Diaz–Brito V, León A, Knobel H, Peraire J, Domingo P, Clotet B, Dalmau D, Cruceta A, Arnaiz JA, Gatell JM, García F. Post-exposure prophylaxis for HIV infection: a clinical trial comparing lopinavir/ritonavir versus atazanavir each with zidovudine/lamivudine. Antivir Ther 2011; 17:337-46. [DOI: 10.3851/imp1955] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2011] [Indexed: 10/15/2022]
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Whitehead T, Fernando I. A review of HIV postexposure prophylaxis provision at a genitourinary medicine department. Int J STD AIDS 2010; 21:837-9. [DOI: 10.1258/ijsa.2010.010227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We undertook a retrospective case-note audit of all patients who presented to the Edinburgh genitourinary (GU) medicine department following a potential exposure to HIV infection during the period 1 January 2006 to 31 December 2008. Over the audit period, 81 individuals attended the department, in relation to 85 exposure events. Twenty-three (27%) exposures had occurred in a health-care occupational setting and 50 (59%) in a sexual context. Baseline HIV testing was only performed in 38 (45%) of the 85 exposures. Postexposure prophylaxis (PEP) was initiated in 65 (76%) cases: 61 (94%) received the first dose within the recommended 72 hours. In 68 (80%) of the 85 exposures, the PEP initiation decision tallied with guideline recommendations. Fifty-six of the 65 individuals started on PEP continued beyond 72 hours; 53 of them were reviewed at least once during the course of PEP and had routine blood monitoring performed. Documentation regarding adherence was poor, with only 31 having this recorded in notes. Thirty-seven (66%) individuals who continued on PEP attended for follow-up HIV testing at three months. In summary, the department performed well in some aspects of PEP provision. However, baseline HIV testing and documentation regarding adherence are unsatisfactory and we suggest recommendations to improve this.
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Affiliation(s)
| | - I Fernando
- Royal Infirmary of Edinburgh, Edinburgh, UK
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Comparison of Two HIV Postexposure Prophylaxis Regimens Among Men Who Have Sex With Men in Amsterdam: Adverse Effects Do Not Influence Compliance. Sex Transm Dis 2010; 37:681-6. [DOI: 10.1097/olq.0b013e3181e2f999] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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The Danish PEP registry: experience with the use of postexposure prophylaxis (PEP) following sexual exposure to HIV from 1998 to 2006. Sex Transm Dis 2010; 37:49-52. [PMID: 19734819 DOI: 10.1097/olq.0b013e3181b6f284] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Studies indicate that antiretroviral postexposure prophylaxis (PEP) after sexual exposure to HIV reduce the risk of infection considerably. Since 1998 PEP after sexual HIV exposure within the preceding 24 hours, has been available in Denmark. PEP can only be prescribed at clinical centers with specialists experienced in HIV treatment. The objective of this study is to describe the use of PEP after sexual exposure from 1998 to 2006. METHODS The Danish PEP registry collects data from all cases of PEP use in Denmark after exposure to HIV through a structured questionnaire. RESULTS There were 374 cases of PEP use after sexual exposure. The incidence increased from 5 cases in 1997 to 87 in 2006. PEP was used by heterosexuals (40%) as well as men who have sex with men (57%). The HIV-status of the source was unknown in 41% of the cases of which 90% involved a source belonging to a high risk group, and 63% involved exposure by receptive anal intercourse. PEP was administered within 24 hours in 95% of the cases and the median time to initiation (N = 225) was 11.0 hours (range 0.5-60.0). PEP was completed by 65%. CONCLUSIONS This nationwide study showed a steady but moderate increase in the use of PEP after sexual HIV-exposure from 1998 to 2006. Time to initiation of PEP was low and the PEP prescription practice was targeted toward high risk exposures.
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Jorgensen P, Marcus U, Albrecht H, Suttorp N, Schürmann D. Serial knife stabbings with HIV exposure--implications for post-exposure prophylaxis. J Infect 2009; 60:76-8. [PMID: 19840818 DOI: 10.1016/j.jinf.2009.10.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Revised: 08/20/2009] [Accepted: 10/14/2009] [Indexed: 10/20/2022]
Abstract
Thirty-three persons became victims of a serial knife stabbing incident. One of the first victims one day later disclosed that he was HIV-infected. Thereafter thirty-one victims initiated HIV post-exposure prophylaxis (PEP), one exposed patient declined. None of the victims evaluated had seroconverted six months later. In most such incidents HIV exposure will be difficult to rule out as reliable information on the HIV serostatus of all serial victims will be lacking. It appears prudent, however, to inform serial stab victims about the potential risk of HIV transmission and to at least consider PEP in such scenarios.
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Affiliation(s)
- Pernille Jorgensen
- Department of Infectious Diseases Epidemiology, Robert Koch Institute, Berlin, Germany
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Poynten IM, Jin F, Mao L, Prestage GP, Kippax SC, Kaldor JM, Imrie J, Grulich AE. Nonoccupational postexposure prophylaxis, subsequent risk behaviour and HIV incidence in a cohort of Australian homosexual men. AIDS 2009; 23:1119-26. [PMID: 19417578 DOI: 10.1097/qad.0b013e32832c1776] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the relationship between nonoccupational postexposure prophylaxis (NPEP) use and future HIV risk behaviours and HIV infection in a cohort of HIV-negative homosexual men in Sydney, Australia. DESIGN Prospective analysis of NPEP use in a community cohort from 2001 to 2007. METHODS In the Health in Men study cohort, men were annually questioned about NPEP use and tested for HIV. Every 6 months, detailed quantitative data on unprotected anal intercourse were collected. Cox regression models examined risk factors for incident NPEP use, HIV seroconversion and time trends in NPEP use. The change in the number of unprotected anal intercourse acts with nonseroconcordant partners before and after NPEP was examined using the Wilcoxon signed-rank test. RESULTS One thousand four hundred and twenty-seven participants were enrolled. At baseline, 78.5% of participants had heard of NPEP, which increased to 97.4% by the fifth annual interview. NPEP use increased significantly from 2.9 per 100 person-years in 2002 to 7.1 per 100 person-years in 2007 (P = 0.007). Unprotected anal intercourse was a strong predictor of incident NPEP use. Use of NPEP was not associated with changes in HIV risk behaviour. Men who received NPEP had a significantly higher rate of subsequent HIV seroconversion (hazard ratio 2.67, 95% confidence interval 1.40-5.08, P = 0.003). CONCLUSION Awareness of the availability of NPEP in this cohort was nearly universal. Use was common and increased rapidly over the study period. NPEP was targeted mostly towards high-risk behaviours. Use of NPEP was not associated with reductions in risk behaviour, and men who received NPEP continued to be at high risk of subsequent HIV infection.
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Guinot D, Ho MT, Poynten IM, McAllister J, Pierce A, Pell C, Grulich AE. Cost-effectiveness of HIV nonoccupational post-exposure prophylaxis in Australia. HIV Med 2009; 10:199-208. [DOI: 10.1111/j.1468-1293.2008.00670.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Vives N, Almeda J, Contreras CA, García F, Campins M, Casabona J. Demanda y prescripción de la profilaxis postexposición no ocupacional al VIH en España (2001-2005). Enferm Infecc Microbiol Clin 2008; 26:546-51. [DOI: 10.1157/13128270] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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23
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Papenburg J, Blais D, Moore D, Al-Hosni M, Laferrière C, Tapiero B, Quach C. Pediatric injuries from needles discarded in the community: epidemiology and risk of seroconversion. Pediatrics 2008; 122:e487-92. [PMID: 18676535 DOI: 10.1542/peds.2008-0290] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Although anxiety exists concerning the perceived risk of transmission of bloodborne viruses after community-acquired needlestick injuries, seroconversion seems to be rare. The objectives of this study were to describe the epidemiology of pediatric community-acquired needlestick injuries and to estimate the risk of seroconversion for HIV, hepatitis B virus, and hepatitis C virus in these events. METHODS The study population included all of the children presenting with community-acquired needlestick injuries to the Montreal Children's Hospital between 1988 and 2006 and to Hôpital Sainte-Justine between 1995 and 2006. Data were collected prospectively at Hôpital Sainte-Justine from 2001 to 2006. All of the other data were reviewed retrospectively by using a standardized case report form. RESULTS A total of 274 patients were identified over a period of 19 years. Mean age was 7.9 +/- 3.4 years. A total of 176 (64.2%) were boys. Most injuries occurred in streets (29.2%) or parks (24.1%), and 64.6% of children purposely picked up the needle. Only 36 patients (13.1%) noted blood on the device. Among the 230 patients not known to be immune for hepatitis B virus, 189 (82.2%) received hepatitis B immunoglobulin, and 213 (92.6%) received hepatitis B virus vaccine. Prophylactic antiretroviral therapy was offered beginning in 1997. Of the 210 patients who presented thereafter, 82 (39.0%) received chemoprophylaxis, of whom 69 (84.1%) completed a 4-week course of therapy. The use of a protease inhibitor was not associated with a significantly higher risk of adverse effects or early discontinuation of therapy. At 6 months, 189 were tested for HIV, 167 for hepatitis B virus, and 159 for hepatitis C virus. There were no seroconversions. CONCLUSIONS We observed no seroconversions in 274 pediatric community-acquired needlestick injuries, thereby confirming that the risk of transmission of bloodborne viruses in these events is very low.
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Affiliation(s)
- Jesse Papenburg
- Infectious Diseases Division, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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Poynten IM, Smith DE, Cooper DA, Kaldor JM, Grulich AE. The public health impact of widespread availability of nonoccupational postexposure prophylaxis against HIV. HIV Med 2007; 8:374-81. [PMID: 17661845 DOI: 10.1111/j.1468-1293.2007.00483.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of the study was to describe the use of nonoccupational postexposure prophylaxis (NPEP) in Australia, and to estimate the number of HIV infections that its use prevented. METHODS We conducted a population-based observational cohort study of people who presented to antiretroviral prescribers in Eastern Australia, and reported a high-risk nonoccupational exposure to HIV, in 1998-2004. Prescribers collected data at baseline, 4 weeks and 6 months. Data collected included details of HIV exposure, drug regimens and HIV serostatus. RESULTS The great majority of the 1601 participants were male (95%) and presented after male homosexual exposure (87%). Only 32% of exposures were to HIV-positive sources. Two antiretroviral drugs were prescribed after 48% of events, and three or more drugs after 52% of events. The median time to receipt of NPEP was 23 h. Side effects were reported by 66% of participants. No case of NPEP failure in an adherent individual was identified. It was estimated that 0.9-9.2 HIV infections had been prevented. This compared with a total of 1138 newly acquired HIV infections notified in the geographical area covered by the study. CONCLUSIONS In Australia, NPEP has been widely prescribed and is mainly targeted at high-risk exposures. Although there were no identified failures of NPEP, it is likely that only a small proportion of new HIV infections in the study area were prevented. NPEP may be a valuable preventive intervention for an individual, but it can only play a minor role in HIV prevention at the population level unless targeting can be further improved.
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Affiliation(s)
- I M Poynten
- National Centre in HIV Epidemiology and Clinical Research, the University of New South Wales, Sydney, Australia
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Roland ME. A model for communitywide delivery of postexposure prophylaxis after potential sexual exposure to HIV. Sex Transm Dis 2007; 34:294-6. [PMID: 17308501 DOI: 10.1097/01.olq.0000258321.62272.0e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jagannathan P, Landovitz R, Roland ME. Postexposure prophylaxis after sexual exposure to HIV. ACTA ACUST UNITED AC 2007. [DOI: 10.2217/17469600.1.1.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Increasing numbers of international, national and state/provincial health organizations in the developed and developing world recommend postexposure prophylaxis (PEP) following potential sexual exposure to HIV. The evidence for these policies is extrapolated from occupational healthcare worker, perinatal prophylaxis and animal studies. There is no direct evidence of PEP efficacy after sexual exposures. Studies addressing potential increases in risk behavior, toxicities and cost–effectiveness are encouraging. Considerations for offering PEP include the timing and characteristics of the exposure and the HIV status of the source and exposed individuals. PEP includes 28 days of a combination antiretroviral drug regimen containing two or more drugs and associated laboratory testing, counseling and referrals. PEP service delivery challenges include ensuring adequate access to services, optimizing PEP adherence and facilitating follow-up HIV testing and counseling. Men who have sex with men, sexual assault survivors, children and adolescents, and individuals in resource-limited settings present unique needs and challenges.
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Affiliation(s)
- Prasanna Jagannathan
- University of California, San Francisco, California, Department of General Internal Medicine, San Francisco General Hospital Ward 13, 1001 Potrero Avenue, San Francisco, CA 94110, USA
| | - Raphael Landovitz
- University of California, Los Angeles, Center for Clinical AIDS Research and Education, David Geffen School of Medicine, 9 911 W Pico Blvd., Suite 980 Los Angeles, CA 90035, USA
| | - Michelle E Roland
- University of California. San Francisco, Positive Health Program, Ward 84, San Francisco General Hospital, 995 Potrero Avenue, San Francisco, CA 94110, USA
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Sonder GJB, van den Hoek A, Regez RM, Brinkman K, Prins JM, Mulder JW, Veenstra J, Claessen FA, Coutinho RA. Trends in HIV Postexposure Prophylaxis Prescription and Compliance After Sexual Exposure in Amsterdam, 2000–2004. Sex Transm Dis 2007; 34:288-93. [PMID: 16980918 DOI: 10.1097/01.olq.0000237838.43716.ee] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate trends in HIV postexposure prophylaxis (PEP) requests after sexual exposure, compliance, and outcome of follow-up HIV tests. STUDY DESIGN The authors conducted a retrospective analysis of all HIV PEP requests after sexual exposure between January 1, 2000, and December 31, 2004, in Amsterdam. RESULTS In 5 years, there was a very modest increase in PEP requests, of which most (75%) came from men who have sex with men (MSM). Although 70% reported side effects, 85% completed their PEP course. Sexual assault victims less often completed their course (odds ratio [OR] = 0.1; 95% confidence interval [CI] = 0.05-0.4, P = 0.001). People who used HIV PEP more often complied with follow-up tests than people who did not use PEP (OR = 3.5; 95% CI = 1.6-7.9, P = 0.002). One HIV seroconversion was found caused by a later exposure than that for which PEP was given. CONCLUSIONS Despite a widely available PEP program in Amsterdam, the number of PEP requests remained low. Most people completed their PEP course; compliance with follow-up HIV testing was high.
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Affiliation(s)
- Gerard J B Sonder
- GGD Amsterdam, Municipal Health Service Amsterdam, Department of Infectious Diseases, Amsterdam, The Netherlands.
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Abstract
PURPOSE OF REVIEW HIV postexposure prophylaxis is often recommended following potential sexual exposure to HIV. Recent data address the effectiveness of postexposure prophylaxis and prevention counseling, cost-effectiveness, antiretroviral options, challenges with nonoccupational postexposure prophylaxis among adolescents and children and following sexual assault in high HIV prevalence areas, and a successful program in Amsterdam. RECENT FINDINGS Postexposure prophylaxis is not completely protective. Seroconversion may result from antiretroviral failure or from ongoing exposures. Postexposure prophylaxis associated risk reduction counseling results in reductions in subsequent risk behavior. Programs that target outreach and limit prescriptions to those with exposure sources who are at risk of being HIV infected are cost-effective. Less restrictive guidelines result in more prescriptions for low-risk exposures; this practice is not cost-effective. The ideal antiretrovirals for postexposure prophylaxis use have not been established. Tenofovir has several attractive properties. Developing systems to support the effective delivery of postexposure prophylaxis among children and adolescents and following sexual assault in high HIV prevalence, resource limited settings is challenging. SUMMARY Numerous national and international guidelines recommend postexposure prophylaxis following potential sexual exposure to HIV. Maximizing adherence and minimizing subsequent HIV exposures will be critical to enhancing the effectiveness of this HIV prevention intervention.
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Affiliation(s)
- Michelle E Roland
- Positive Health (AIDS) Program at San Francisco General Hospital, University of California, San Francisco, California 94110, USA.
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Oh MD. Antiretroviral Therapy for Treatment of Human Immunodeficiency Virus Type 1 Infection. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2007. [DOI: 10.5124/jkma.2007.50.4.316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Myung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Korea.
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Cohen MS, Kashuba ADM, Gay C. HIV Antiretroviral Postexposure Prophylaxis: A Cautionary Note. Clin Infect Dis 2005; 41:1514-6. [PMID: 16231266 DOI: 10.1086/497274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2005] [Accepted: 07/20/2005] [Indexed: 11/03/2022] Open
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Abstract
Health care providers in a variety of settings need to improve their ability--along with the capabilities of supporting laboratories, surveillance systems, and services for sex partner management--to diagnose and treat STI. Whether the travel health care sector, as such, is willing to take on the additional burden of STI-related screening and risk reduction counseling has been raised by some authors. Currently, the burden of providing formalized STI care falls on the public sector; however, in the United States, most STI are actually diagnosed in the offices of private physicians. Given that the United States has the highest STI rates of any industrialized country, the undeniable synergy between STI and HIV acquisition, the failure of many American providers to screen for C trachomatis despite clear guidelines, the global resurgence of syphilis and extension of resistant N gonorrhoeae and of HIV, and the risk behaviors consistently reported by travelers, it is hard to argue against travel specialists' joining the daunting battle against these recalcitrant infections and their often devastating consequences. Most of the relevant diagnostic tests are relatively affordable, and patient-centered risk-reduction counseling, once mastered, can be brief and easily integrated into the overall conversation about protecting oneself during travel.
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Affiliation(s)
- Jeanne M Marrazzo
- Division of Allergy and Infectious Diseases, University of Washington, Harborview Medical Center, Seattle, WA 98104, USA.
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Abstract
The number of people infected with HIV continues to increase relentlessly. Post-exposure prophylaxis (PEP) following exposure to HIV infection may prevent established HIV infection. Such intervention is supported by biological plausibility and limited data from animal and human studies. Antiretroviral prophylaxis is associated with significant side effects and the risk should be weighed against the potential benefits. PEP should be considered after significant occupational and non-occupational exposures. However, PEP is not suitable for individuals with repeated high-risk behaviour who are not willing to adhere to risk reduction practices. Primary prevention strategies remain the mainstay for control of the HIV epidemic and cannot be replaced by PEP. Guidance for PEP following exposure to HIV infection is available in many countries worldwide.
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Affiliation(s)
- Ali S Omrani
- Infectious Diseases Unit, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK.
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