Background: The occupational post exposure prophylaxis for HIV is systematized and applied in most of the european countries since 1998. Its efficacy and the social demand pose the problem of the prophylaxis for HIV after a non occupational exposure: its feasibility, its effectiveness, and its standardization in Europe.
Objectives: Our objectives were to update the situation of the NONOPEP for HIV if Europe: its recommendations and its availability in the european countries who are involved in the implementation of a very recent European Registry on NONOPEP, and to present the preliminary results of this registry.
Methods: The EURO-NONOPEP STUDY, with 14 participant countries, has being financed by the European Commission: register number 2000/SID/108. A questionnaire has being elaborated and sent to every representative of the participant countries, for collecting data about: the existence of a national, regional or hospital Guidelines of NONOPEP, the existence of a national NONOPEP registry (its starting date, its number of cases, if it is a communal registry for occupational and for non occupational post exposure prophylaxis), and the existence of an information campaign about NONOPEP. A prospective registry form for the patients who consult after a non occupational post exposure for HIV, receiving or not a preventive antiretroviral treatment
(ART), has been designed. From April 2001 to June 2002, this registry, containing three follow-up forms (at the initial consultation, at 1month and at 6 months follow up) will collect the data concerning the details of these exposures: the type of exposure, the treatment given, its side effects, the compliance of the patients, and the rate of sero-conversion regarding the treatment taken.
Results: 6 participant countries (Belgium, France, Germany, Holland, Italy, Switzerland) have a National Guidelines for NONOPEP, starting from 97 to 99. 4 participant countries (France, Holland, Italy, Switzerland) have an effective national registry for NONOPEP. The total of cases of NONOPEP collected by these registries was 2074, from June 97 to May 2000. In Switzerland, only the patient who receive an ART are registered. The preliminary data of the European Registry, 2 months after its beginning were the following : 112 cases collected, 58 (51,8%) sexual exposures, 43 (38,4%) parenteral exposures, and 11(9,8%) other types of exposure. 66,1% of the patients was men, and their median age 29,27 years old (from 5 to 64). The mean time
elapsed between the exposure and the first consultation was 14h30mn (from 33mn to 2 months). In 57,14% of the cases, the status of the source person was unknown. 54,8% of the exposures was considered as a low risk by the physicians, 27,4% as an intermediary risk, and 16,7% as a high risk. Nevertheless, 57,1% of the patients received ART, and 22% of them was considered exposed to a low risk of infection. These treatments was different, depending on the country, and sometime in the same country depending on the physician: 70,31% of the ART prescribed was trithérapy, 23,4% bitherapy and 6,2% quadritherapy. It is too early to evaluate the rate of lost of follow up.
Conclusions: In the majority of the european countries, there are neither national guidelines nor national registry on NONOPEP. The number not negligible of cases already collected by the existing registries, confirm that the demand of NONOPEP is indisputable. The risk evaluation, the indication and the type of treatment are very variable. The question about the effectiveness, the feasability and the european standardization of the policies of the non occupational post exposure prophylaxis for HIV is still a topical question and justifies the need of an European Registry to collect and analyse the data of the patients who consult for a NONOPEP.
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