The Danish PEP Registry: Experience with the Use of Post-Exposure Prophylaxis Following Blood Exposure to HIV from 1999-2012

BACKGROUND:

The risk of occupational exposures to blood cannot be eliminated completely and access to post-exposure prophylaxis (PEP) to prevent HIV transmission is important. However, PEP administration has been associated with frequent adverse effects, low compliance and difficulties to ensure a proper risk assessment. This nationwide study describes 14 years of experience with the use of PEP following blood exposure in Denmark.

METHODS:

A descriptive study of all PEP cases following non-sexual exposure to HIV in Denmark from 1999-2012.

RESULTS:

A total of 411 cases of PEP were described. There was a mean of 29.4 cases/year, increasing from 23 cases in 1999 to 49 cases in 2005 and then decreasing to 16 cases in 2012. Overall 67.2% of source patients were known to be HIV-positive at the time of PEP initiation, with no significant change over time. The median time to initiation of PEP was 2.5 h (0.15-28.5) following occupational exposure. Adverse effects were reported by 50.9% with no significant difference according to PEP regimen. In 85.1% of cases with available data, either a full course of PEP was completed or PEP was stopped because the source was tested HIV-negative. Only 6.6% stopped PEP early due to adverse effects.

CONCLUSIONS:

PEP in Denmark is generally prescribed according to the guidelines and the annual number of cases has declined since 2005. Adverse effects were common regardless of PEP regimens used and new drug regimens should be considered.

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By:   Lunding S1, Katzenstein TL2, Kronborg G3, Storgaard M4, Pedersen C5, Mørn B6, Lindberg JÅ7, Kronborg TM8, Jensen J9.

• 1a Department of Pulmonary and Infectious Diseases , Nordsjælland Hospital , Hillerød , Denmark.
• 2b Department of Infectious Diseases , Rigshospitalet , Copenhagen , Denmark.
• 3c Department of Infectious Diseases , Hvidovre Hospital , Hvidovre , Denmark.
• 4d Department of Infectious Diseases , Skejby Hospital , Århus , Denmark.
• 5e Department of Infectious Diseases , Odense Hospital , Odense , Denmark.
• 6f Department of Infectious Diseases , Ålborg Hospital , Ålborg , Denmark.
• 7g Department of Medicine , Herning Hospital , Herning , Denmark.
• 8h Medical Faculty, Copenhagen University , Copenhagen , Denmark.
• 9i Department of Medicine , Kolding Hospital , Kolding , Denmark.
• Infect Dis (Lond). 2016 Mar;48(3):195-200. doi: 10.3109/23744235.2015.1103896. Epub 2015 Nov 3.
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Outcomes of a Postexposure Prophylaxis Program at the Korle-Bu Teaching Hospital in Ghana: A Retrospective Cohort Study

The risk for occupational exposure to HIV is a serious public health problem that is well characterized in the developed world, but less so in the developing countries such as Ghana. This study was undertaken to examine the characteristics of occupational exposure to HIV and the utilization of a risk assessment system (RAS)–based postexposure prophylaxis (PEP) among health care workers (HCWs) and health care students (HCSs) in the Korle-Bu Teaching Hospital (KBTH). 

During the study period (January 2005–December 2010), a total of 260 and 35 exposures were reported by HCWs and HCSs, respectively. Ward attendants reported the highest incidence rate of 6.46 of 100 person-years (P-Y). The incidence of high-risk exposures was 0.33 of 100 P-Y (n = 65); 60.0% occurred during a procedure of disposing of a needle and 24.6% during a cannula insertion. A total of 289 of the 295 individuals were administered PEP, of which 181 (62.6%) completed the 6-month follow-up testing schedule and none sero-converted. 

This shows that with a good RAS in place, it is possible to deploy an effective PEP program in a typical African teaching hospital like the KBTH in Accra, Ghana.

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By:   Raymond A. Tetteh, MSc, FPC Pharm1,2⇑, Edmund T. Nartey, MPhil3, Margaret Lartey, MB ChB, MPH, FWACP4, Aukje K. Mantel-Teeuwisse, PharmD, PhD1, Hubert G. M. Leufkens, PharmD, PhD1,5, Priscilla A. Nortey, PhD, FPC Pharm6 ,Alexander N. O. Dodoo, PhD, FPC Pharm3

1. ¹Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
2. ²Pharmacy Department, Korle-Bu Teaching Hospital, Korle-Bu, Accra, Ghana
3. ³Centre for Tropical Clinical Pharmacology & Therapeutics, University of Ghana Medical School, Accra, Ghana
4. ⁴Department of Medicine, University of Ghana Medical School, Accra, Ghana
5. ⁵Medicines Evaluation Board, Utrecht, the Netherlands
6. ⁶Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana

1. Raymond A. Tetteh, Pharmacy Department, Korle-Bu Teaching Hospital, P.O. Box KB 77, Korle-Bu, Accra, Ghana. Email: r_niiatetteh@yahoo.com

 

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Occupationally Acquired HIV Infection by Healthcare Personnel–United States, 1985-2013

Results: During 1985-2013, 58 confirmed (figure) and 150 possible cases of occupationally acquired HIV by HCP were reported to the CDC. Among the 58 confirmed cases, the routes of exposure were percutaneous puncture or cut (n=49), mucocutaneous exposure (n=5), both percutaneous and mucocutaneous exposure (n=2), and unknown (n=2). The exposures were to HIV-infected blood (n=49), concentrated virus in laboratories (n=4), visibly bloody body fluid (n=1), and unspecified body fluids (n=4). Since 1999, only one confirmed case has been reported.

Conclusions: Confirmed cases of occupationally acquired HIV require documented seroconversion temporally related to a specific exposure. Occupational acquisition of HIV infection by HCP is now exceedingly rare.

Via http://ht.ly/K4U1O HT @CDCgov