There is limited evidence on the efficacy of post-exposure
prophylaxis (PEP) for sexual exposures. We sought to determine the factors
associated with adherence to treatment and describe the incidence of PEP
failures in a Montreal clinic.
We prospectively assessed all patients consulting for PEP
following sexual exposures from October 2000 to July 2014. Patients were
followed at 4 and 16 weeks after starting PEP. Treatment adherence was
determined by self-report at week 4. Multivariable logistic regression was used
to estimate the factors predicting adherence to treatment.
3547 PEP consults were included. Patients were mainly male
(92%), MSM (83%) and sought PEP for anal intercourse (72%). Seventy-eight
percent (n = 2772) of patients received a prescription for PEP, consisting of
Tenofovir/Emtracitabine (TVD) + Lopinavir/Ritonavir (LPV) in 74% of cases,
followed by Zidovudine/Lamivudine (CBV) + LPV (10%) and TVD + Raltegravir (RAL)
(8%). Seventy percent of patients were adherent to treatment. Compared to
TVD+LPV, patients taking CBV+LPV were less likely to adhere to treatment (OR
0.58, 95% CI 0.44–0.75), while no difference was observed for patients taking
TVD+RAL (OR 1.15, 95% CI 0.83–1.59). First-time PEP consults, older and male
patients were also more adherent to treatment. Ten treated patients
seroconverted (0.37%) during the study period, yet only 1 case can be
attributed to PEP failure (failure rate = 0.04%).
PEP regimen was associated with treatment adherence.
Patients were more likely to be adherent to TVD-based regimens. Ten patients
seroconverted after taking PEP; however, only 1 case was a PEP failure as the
remaining patients continued to engage in high-risk behavior during follow-up.
One month PEP is an effective preventive measure to avoid HIV infection.
Full article at: http://goo.gl/ogXhPl
By:
Clinique médicale l’Actuel,
Montreal, Quebec, Canada
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