Background HIV post-exposure prophylaxis protocol (PEP) was implemented in collaboration with the Emergency Department (ED). The PEP begins with dispensation in the ED of antiretroviral treatment (ART) for 10 days, if no more than 72 hours’ post-exposure have elapsed. Later patients must visit the Internal Medicine Department. If ART is indicated, a dispensation in the Pharmacy Department until completing 1 month of treatment is performed. The PEP ends with serology control at 3 months’ post-exposure.
Study characteristics of patients who initiate PEP.
Assess indication of treatment based on protocol.
Determine adherence of patients to complete PEP.
Material and methods Retrospective observational study from June 2014 to June 2017, which included patients who came to the ED for HIV risk contact and began PEP.
Age and sex, reason for visit to ED, indication according to protocol, ART dispensed, adverse reactions (AR) and serology control at 3 months’ post-exposure were recorded. Data were obtained from SAP® electronic medical records.
Results We included 52 patients, with a mean age of 30±8 years: 86% (n=45) males and 14% (n=7) females. Six per cent (n=3) of cases were victims of work-related accidents, 2% (n=1) for assault with knife, 3% (n=2) for accidental puncture and 89% (n=46) sexual risk contact, of which 59% (n=28) homosexuals and 41% (n=18) heterosexuals.
Fifty eight per cent of patients (n=30) started ART with combivir +kaletra, 10% (n=5) with truvada +kaletra and 32% (n=17) with truvada +isentress (according to protocol and treatment guides’ updates). Treatments were indicated in 36 cases. In the remaining 16, ART was discontinued in six patients due to lack of indication and there was loss of follow-up in 10 cases.
Twenty-one per cent of patients (n=11) suffered AR: 73% (n=8) had gastrointestinal discomfort, 27% (n=3) headache, 18% (n=2) asthaenia and 9% (n=1) subconjunctival jaundice. In two cases, an ART change from combivir +kaletra to truvada +isentress was necessary.
Regarding adherence, serological control was performed in 46% of patients (n=24): 100% of these controls were negative. The remaining 54% (n=28) did not perform the corresponding serology.
Finally, 4% (n=2) of patients required PEP in several visits to the ED.
Conclusion Patients who initiate PEP are mostly males who have maintained risky homosexual contact. ART is effective and is indicated in most cases: it presents AR that are usually light and manageable.
Pharmacists can play an important role in improving patients’ PEP compliance, which includes serology control at 3 months’ post-exposure, aiming to improve the adherence. Also, it would be advisable to prioritise training measures in this population group to minimise exposure to contagion risk.
No conflict of interest