Insight and Information on Post-Exposure Prophylaxis
October 1, 2001
Note: In response to the questions received in the past few weeks in regard to post-exposure prophylaxis (PEP), STEP has decided to send out a small briefing on what PEP is and what is the best use for PEP (either occupational use or non-occupational use).
The overall transmission rate of HIV infection following occupational exposure is estimated to be approximately 0.3%. Since the first reported case of seroconversion following occupational exposure to HIV, there have been 315 additional cases of occupationally acquired infection. Several animal studies have shown that the administration of antiviral drugs following, or just before, HIV exposure reduces the rate of viral transmission with varying degrees of efficacy. In addition, a case-control study of healthcare workers in France, the United Kingdom, Italy, and the United States showed that the use of zidovudine (AZT) was associated with an 81% reduction in the risk of HIV infection following occupational exposure. These results have led to the establishment of protocols for the administration of post-exposure prophylaxis (PEP) for HIV infection following occupational exposure.
There is also an increasing body of literature advocating the use of PEP following sexual exposure to HIV, although there are currently no data to support this. PEP is routinely recommended following occupational exposure to HIV. Most PEP regimens involve the use of two nucleoside reverse transcriptase inhibitors with or without the addition of a protease inhibitor. PEP is also increasingly being prescribed following nonoccupational exposure to HIV. It is important that careful risk assessment be performed before prescribing PEP in both the occupational and nonoccupational settings and that risk reduction measures be emphasized. In the last STEP Ezine, we addressed the new guidelines for administering PEP.
This article was provided by Seattle Treatment Education Project. It is a part of the publication STEP Ezine.