Background The World Health Organisation recognises the need to improve uptake and completion rates for postexposure prophylaxis (PEP).
Purpose To analyse PEP dispensed by the pharmacy service to patients after an occupational (OE) or nonoccupational (NOE) exposure to the human immunodeficiency virus (HIV).
To compare usual clinical practice in our centre for PEP to European acquired immune deficiency syndrome (AIDS) Clinical Society guidelines.1
Material and methods A descriptive, observational and retrospective study performed in a third-level hospital regarding PEP dispensed from January 2015 to March 2018. The following data were retrieved from an electronic prescription program management tool (outpatients’ clinical module) and electronic clinical records: sex, age, year, time from exposure, nature of exposure (sexual contact (SC) vs blood contact (BC)), OE vs NOE, service of the prescribing doctor, antiretroviral drugs (AD) prescribed, following monitoring in outpatient visit, positive infection detected after PEP, further episodes of PEP and positive infection nowadays.
We reviewed the current version of the European AIDS Clinical Society guidelines.1
Results Current guidelines recommend 4 week treatment with AD after OE or NOE as early as possible (no later than 48/72 hours). PEP regimen: emtricitabine/tenofovir disoproxilfumarato (FTC/TDF)+raltegravir (RAL) or darunavir/ritonavir (DRV/r) or lopinavir/ritonavir (LPV/r). Re-evaluation of PEP indication by HIV experts is recommended within 48–72 hours.
Clinical records of 57 patients were analysed: distribution per year 2015 24.5% (n=14), 2016 33.3% (n=19), 2017 33.3% (n=19), 2018 8.7% (n=5). Median age 29.9 years, 77.2% (n=44) males. Time from exposure <72 hour in 66.6% (n=38) of patients. Nature of exposure SC 61.4% (n=35), BC 14% (n=8), rest unknown. NOE 77,2% (n=44). Preventive medicine doctors prescribed 78.9% (n=45) of PEP, emergency room doctors 14% (n=8), and infectious diseases doctors 7% (n=4). AD prescribed were: elvitegravir/cobicistat/TDF/FTC 80.7% (n=46), RAL +TDF/FTC 15.7% (n=9), LPV/r+TDF/FTC 3.5% (n=2). Monitoring in outpatient visit 51.7% (n=30). Nopositive HIV infection was registered. Further episodes of PEP 5.2% (n=3).
Conclusion PEP is more frequently prescribed in young males after NOE by SC, and in our centre is not uniform regarding prescribing doctor, AD used or subsequent monitoring of patients.
Our clinical practice differs from European guidelines in AD use and patient monitoring. In order to comply with those guidelines, we will implement a protocol to optimise PEP prescription and patient follow-up.
References and/or acknowledgements 1. European AIDS Clinical Society (2017). EACS guidelines version 9.0, October 2017.
No conflict of interest.