Background and Importance Preventing human inmunodeficiency virus(HIV) transmission is a major public health challenge. Consideration is given to the role of post-exposure treatment(PEP) of HIV prevention strategies.
Aim and Objectives To describe the adequacy, adherence and safety of PEP.
Material and Methods A retrospective observational study conducted in a tertiary hospital: patients older than16 years old treated with PEP who consulted to emergency department(ED) January2021-july2022. Sex, age, risk and type exposure, adequacy of PEP based in clinical guidelines (<72 hours to start PPE, combination:EMTRICITABINE/TENOFOVIR/RALTEGRAVIR), previous PEP, HIV-status source, basal/monthly serology, dispensing-shift, suitable patient for pre-exposure treatment(PrEP), adherence, completeness and safety of PEP were collected as variables. Statistical analysis was performed using Stata MPv17.0.
Results 70 patients(67.14% men; median age 24.44, Interquartile range[IQR:21.69–35.91]) visited de ED 77 times to get PEP: 5/70(7.14%) presented twice and 1/70(1.43%) three times. 13/70(18.57%) were suitable to start PrEP and 1/13 had already started PrEP.
67/77(87.01%) of dispensing treatment were carried out in our centre and 70/77(90.90%) were the standard combinations. Exposure risk were: 36/77(46.75%) low, 32/77(41.56%) minimum, 7/77(9.09[CU1]%) high and 2/77(2.60%) unknown. Of all, only 3/77(3.89%)PEP were not adequate according clinical guidelines. All patients were provided by pharmaceutical care and a large proportions of all PEP visits 46/77(59.74%) were between 10pm-8am.
75/77(97.40%) of exposure were non-occupational: 54/75(72%) sexual exposure, 18/75(24.00%) suspected sexual aggression and 3/75(4.00%) accidental puncture. Most of HIV-status of the source were unknown(63/77;81.82%), followed by positive status(12/77;15.58%) and negative status (2/77;2.60%). HIV serologies at the baseline were negatives(72/77) or unknown(4/77) except 1 who had positive status. In the monthly serology, most of the patients had a negative result(55/76) or unknown due to loss of follow-up(LFU)(21/76).
After finishing PEP, 60/77(77.92%) patients had adherence, 8/77(10.39%) had no-adherence and 12/77(15.58%) unknown because of LFU.
21/77(27.27%) PEP were not finished due to LFU(15/21;71.43%), medical decision (5/21;23.81%) or treatment intolerance(1/21;4.76%).
Side effects(SE) were reported in 24/77(31.17%):(4;16.66%) patients reported moderate SE[CU2].
Conclusion and Relevance In summary, PEP decision-making was adequate in the majority of visits. It should be noted the large number of patients who are LFU[CU1] . Therefore, work should be done to avoid such losses.
Conflict of Interest No conflict of interest
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