• Treatment of sexual assault. A multicenter study in emergency medico-legal units in the Paris region (TuOr314)
  Authored by J.P. Benais, A. Miara, S. Brion, D. Delaitre, P. Werson, A. Soussy, M. Garnier (France)

• Prophylaxis after non-occupational HIV exposure: an overview of the policies implemented in 27 European countries (TuOrC316)
  Authored by D. Rey, M.K. Den Diane, J.P. Moatti (France)

Post-exposure chemoprophylaxis with antiretroviral therapy is the standard of care for health care workers who sustain high-risk occupational exposures to HIV in the United States. The use of antiretroviral therapy to prevent seroconversion after high-risk sexual encounters remains controversial. Several programs are underway across the U.S. to evaluate the safety and efficacy of PEP in the US, but to date PEP has not been made widely available. Two presentations at this year's conference reviewed the experience with post-exposure prophylaxis (PEP) in European countries. Rey and colleagues performed a survey of 27 European countries to determine the availability of PEP for non-occupational exposures (TuORC316). PEP is theoretically available in 18 of 27 countries surveyed, however only six countries had detailed procedures in place for people to access these services, and promotion of PEP services is only available in two countries. These authors concluded that lack of public awareness combined with geographical and economic limitations has led to the limited availability of PEP in most European countries.

Benais and colleagues reviewed current experience with the use of PEP for victims of sexual assault in Paris. These authors described a program that has been in place since June 1999 that provides antiretroviral therapy to sexual assault victims if they present within 48 hours of the attack. Due to concerns about possible AZT resistance in the population, this group chose to use a three-drug combination of ddi, D4T, and nelfinavir. Treatment is continued for 30 days and the clinical evaluations and laboratory tests are performed on days 0, 2, 15, 30 and 60. This PEP regimen was used in 100 patients in the past year. Two perpetrators were known to be HIV-positive, the rest were of unknown status. One quarter of the patients who received PEP never returned for follow-up. No cases of HIV seroconversion were identified. The regimen was safe and well-tolerated without evidence for toxicity during laboratory monitoring. While this study is too small to document the efficacy of PEP, the safety of the regimen is encouraging. The authors concluded that they plan to continue this program. These results suggest that programs can be put in place to make PEP available to treat exposures that occur outside the health care setting.