Ten years of non-occupational HIV post-exposure prophylaxis: what have we learned?

Background

Non-occupational HIV post-exposure prophylaxis (nPEP) has been prescribed in Switzerland for more than a decade. Large population-based analysis of nPEP over such a period has rarely been studied.

Methods

We conducted a retrospective analysis of all nPEP requests between 1998 and 2007 in a single nPEP reference center. Global results as well as trend over time were analysed.

Summary of results

Number of nPEP requests increased from 20 to 191 (>850%) over the study period. Among 1,205 events, 51% were heterosexual exposure, 13% homosexual exposure, 6% sexual assaults, and 23% needlestick and other percutaneous injuries. Sixty-six percent of exposed patients were males, 6% injection drug users, 3% commercial sex workers, 14% clients of commercial sex workers, and 5% cleaning personnel. HIV status of source persons was positive in 23%. For the remaining 920, active tracing allowed to test 313 persons and identified 11 undiagnosed HIV individuals (3.5%). nPEP was recommended for 990 events but could be avoided or interrupted in 290 cases when the source was tested negative. Out of 784 patients who started nPEP, 57% reported side-effects, which led to treatment interruption in 52 cases. There were two HIV seroconversions, none of which was attributed to nPEP failure.

Conclusion

nPEP requests increased over time. Testing the source person for HIV allowed to avoid nPEP in 29% of cases, and is therefore paramount in the management of potential HIV exposure. Furthermore, it allows active screening of high-risk behaviour population for undiagnosed HIV infection, as shown by our prevalence of 3.5%. This number may justify nPEP prescription in cases where HIV status of the source cannot be determined.