Treatment News

Compiled by Gus Cairns

Only half of patients check to see if PEP has worked

A French study has found that although the national system for providing post-exposure prophylaxis (PEP – HIV drugs to prevent infection) after sexual exposure seems to be working quite well, only half of patients given PEP return a month later to be re-tested and see if it has worked.

During 2005 90 patients asked for PEP at the Pitié-Salpetrière Hospital in Paris, one of France’s largest HIV clinics.

Three-quarters of them were men and half of them were gay men, with an average age of 29. Only one in five definitely knew that their partner had HIV, and four of the 90 reported that their contact was ‘HIV-negative’, so it’s not clear why they were seeking PEP. Condoms were not used in just over half the encounters; in 40% of the others, their use was ‘dysfunctional’, i.e. with breakage, slippage and so on. Two people turned up after non-sexual encounters, one from a bite and one after contact with blood.

Although in a lot of cases the HIV risk was pretty low, 80 out of the 90 were given PEP, highlighting, say the researchers, “the issue of the medical decision for these patients in the context of stress and anxiety.”

The average delay between the risk incident and starting PEP was 18 hours and was only more than 48 hours in five patients.

The standard combination prescribed at the hospital was Combivir® (AZT + 3TC) plus Kaletra® (lopinavir/r), and the researchers wonder if tolerability “could be improved with new antiretroviral agents,” because 17.5% of patients had to have their prescription changed due to side effects, usually diarrhoea.

The biggest problem was that too few patients turned up for their follow-up appointments. Only two-thirds turned up after their month of PEP and although their adherence seemed to be almost perfect, it tells us nothing about the other third. And only 50% turned up a month later for a follow-up HIV test, spo although no-one who did turned out to have HIV, oit tells us little about whether PEP worked for everyone.

“Patients’ adherence to follow-up HIV testing should be reinforced to validate the PEP strategy,” say the researchers.

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