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The Body Covers: The 38th Annual Meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy
I-161: Experience of Health-Care Workers (HCWs) Taking Postexposure Prophylaxis (PEP) after Occupational HIV Exposures: Findings of the HIV PEP Registry

September 26, 1998

The HIV PEP Registry was established by the CDC after the US Public Health Service first recommended in 1996 the use of combination antiretroviral therapy as prophylaxis immediately following certain occupational HIV exposures, in an effort to collect data regarding the safety and outcome of PEP. From October 17, 1996 through August 15, 1998, 432 HCWs were confidentially enrolled in a prospective manner into the Registry. Data about the types of exposure and the medium of risk exposure demonstrates:


Exposure Type

Percutaneous 85%
Mucous membrane 9.5%
Skin 7.2%


Medium of Exposure

Blood or blood product 71%
Visibly bloody fluid 13%
Concentrated HIV 2.3%
Unknown 13%
Other (saliva, emesis, tissue, sputum) 8.6%


The median time from exposure to receipt of treatment was 9.9 hours (range 0 - 343 hrs) and consisted of a panoply of combinations too numerous to mention here. However, it can be said that 273/432 pursued a three drug regimen, and of the 358 with 6 weeks follow up, only 158 (44%) completed PEP as initially prescribed. Of the 200 (56%) who discontinued at least one drug from combination therapy, 38% of these did so because the source patient was ultimately discovered to be HIV negative, 54% adjusted therapy in response to undesirable side effects, 31% made changes of their own choice, and 15% changed as a result of the judgement of the treating physician. Side effects were prevalent (in 260/358 at 6 weeks follow up) and were usually reported within a median of 3-4 days following treatment commencement. These side effects consisted of

  • Fatigue/malaise 37%
  • Vomiting 16%
  • Headache 16%
  • Diarreah 14%
  • Myalgia/arthralgia 7%

Only 14% of the HCWs with 6 week follow up were reported to manifest any laboratory abnormalities, but upon review of the abnormalities none were found to be of significance. Unfortunately, the study is unable to correlate any toxicity to any specific drug, and because there is no comparison for adverse events (HCWs with HIV exposure but who did not take PEP were not enrolled) no definitive conclusions can be made regarding the rates of occurrence of toxicity. As a result of the data gathered so far, the authors urged healthcare providers to carefully counsel individuals on PEP in order to advise about side effects and ways to manage them. Some good news: no official seroconversions were reported in the cohort. More information about The HIV PEP Registry can be obtained via phone, fax or internet:

Phone: 888-PEP-4HIV
Fax: 888-800-1052
Internet: http://www.cdc.gov/ncidod/hip/Blood/expose.htm

Reference

Abstract: Experience of Health-Care Workers (HCWs) Taking Postexposure Prophylaxis (PEP) after Occupational HIV Exposures: Findings of the HIV PEP Registry
Authored by: S. A. Wang et al

See Also
More News and Research on Post-Exposure HIV Prevention for Occupational Exposure



  
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Please note: Knowledge about HIV changes rapidly. Note the date of this summary's publication, and before treating patients or employing any therapies described in these materials, verify all information independently. If you are a patient, please consult a doctor or other medical professional before acting on any of the information presented in this summary. For a complete listing of our most recent conference coverage, click here.

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