AEGiS-14IAC: Surveillance of Post-Exposure Prophylaxis for Non-Occupational HIV Exposures Through the U.S. National Registry.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Surveillance of Post-Exposure Prophylaxis for Non-Occupational HIV Exposures Through the U.S. National Registry.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. MoOrD1107)

Grohskopf LA, Smith DK, Kunches LM, Robert LM, McGowan L, Paxton LA, Greenberg AE
Centers for Disease Control and Prevention, Atlanta, GA, United States

BACKGROUND: Better characterization of frequency of use and efficacy of post-exposure prophylaxis for non-occupational HIV exposures (nPEP) is needed to formulate guidelines for its use.

METHODS: A U.S. national registry was established in 1999 for voluntary reporting of non-occupational HIV exposures and nPEP use. Participating healthcare providers (HCPs) reported patient demographics, exposure and source characteristics, antiretroviral drug use, adverse events, and follow-up HIV testing.

RESULTS: From June 1999-March 2001, 49 HCPs reported 219 exposures in 11 states; 71% exposed patients were male. Almost all exposures were sexual (91%) or injection-related (8%). Of sexual exposures, most involved receptive and insertive anal intercourse (40% and 21%), followed by receptive and insertive oral (26% and 17%) and receptive and insertive vaginal (24% and 11%) intercourse (>1 exposure type could be reported). nPEP was offered to 212 (97%) patients and initiated by 207 (95%). The most common initial drug regimens were AZT/3TC (41%) and AZT/3TC/nelfinavir (29%). Of 107 patients for whom follow-up data were available, initial nPEP regimens were completed in 78% cases, modified in 12%, and stopped in 10%; modifications or stops were due to symptoms in 50%, patient choice in 29%, provider decision in 25%, source patient being found negative in 8%, and abnormal lab tests in 4% (>1 reason could be given). To date, follow-up testing has been reported at 4-6 weeks for 59 (27%) patients and 6 months for 14 (6%) patients. One seroconversion was reported in a patient who took a 28-day course of d4T/3TC 11 hours after insertive anal exposure to rectal fluid; investigation of this case is pending.

CONCLUSIONS: This registry continues to provide information on types of exposures for which nPEP is sought, regimens used, rates of completion, and reasons for stopping or altering nPEP. Identification and investigation of potential nPEP failures will aid assessment of efficacy of nPEP.

Keywords: AEGIS, HIV Infections, Anti-HIV Agents, Registries, Lamivudine, Zidovudine, United States, Nelfinavir, HIV, Health Personnel, HIV Seropositivity, Antiretroviral Therapy, Highly Active, HIV Seroprevalence, Male, Human, Female, prevention & control, epidemiology, therapy, drug therapy

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MoOrD1107