The Body Covers: The 36th Annual Meeting of the Infectious Diseases Society of America
Abstract 397: Non-Occupational Post-Exposure Prophylaxis (PEP) vs. HIV in a Boston Community Health Center
November 13, 1998
This paper describes the implementation of a non-occupational, post-exposure prophylaxis protocol against HIV in a community health center in Boston that cares for a large number of HIV infected patients. The protocol was developed and implemented in response to clinicians fielding questions regarding PEP for sexual exposure and after the CDC Consensus Conference on PEP/PET. A pilot program was initiated in September 1997 in conjunction with local hospitals, ADAP, public health department and pharmaceutical industry. A multidisciplinary team was developed between nurses, primary care and mental health providers and epidemiologists who provided 24 hour access to a clinician and a wide array of ancillary services (medication, laboratory testing, mental health counseling, patient education and risk reduction counseling).
During the one-year study period beginning September 1997, there were 47 requests for PEP, of which 38 (81%) were recommended to take PEP. Of these 38 episodes, 33 elected to take PEP. Of all requests for PEP, 70% started PEP. White gay men were the most likely group to request PEP and to be enrolled. The major reasons for seeking PEP among enrollees was unprotected receptive anal intercourse (N=13), unprotected receptive vaginal intercourse (N=6), unprotected receptive oral sex (N=6), unprotected insertive anal (N=4) and vaginal (N=4) intercourse and shared syringe (N=2). Reasons for not enrolling in the PEP protocol include: not having a high risk for HIV transmission (N=4); having a known or suspected HIV seronegative partner (N=4); no reported reason (N=3); being outside of the 72 hour window (N=2); and, receiving PEP for occupational exposure elsewhere (N=1). Of note, 17 (~30%) exposures were with known HIV+ partners. The time between potential HIV exposure and initiation of PEP was ~37 hours (range 1-88 hours). All patients were placed on a standard HAART regimen including a potent protease inhibitor. Of the 28 evaluable individuals who elected to take PEP (five are still on therapy), 24 (86%) completed therapy. No HIV seroconverters were detected. These data are in contradistinction to data described among individuals from studies of occupational exposure to HIV where <50% of individuals completed HAART PEP therapy. In addition, this study demonstrates that through implementation of a multidisciplinary approach, non-occupational PEP is feasible, but requires an immediate response by clinical staff and supportive counseling to initiate and complete PEP therapy.
Authored by: Mayer K, LaSalvia T. Church D, Peterson N, Kwong, J, Appelbaum J, Boswell S
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