|
Background of study: According to German as well as many other national guidelines for HIV Postexposure Prophylaxis (HIV-PEP) the prophylactic administration of antiretroviral drugs can be indicated after a sexual HIV exposure. The timely start of HIV-PEP is crucial for its beneficial effect. In sexual exposures, this timely initiation is often difficult to accomplish compared to occupational exposures.
Objective: 1. To assess the frequency of sexual HIV exposures among serodiscordant couples. 2. To test an emergency kit of antiretroviral drugs for the timely initiation of HIV-PEP. 3. To assess the ability of study participants to adequately decide on the start of HIV-PEP. 4. To test whether the availability of HIV-PEP increases risk behavior among serodiscordant couples.
Design: 24 HIV-seronegative individuals living in homo- or heterosexual relationships with HIV-positive partners were counseled about safer sex and HIV-PEP and provided with an emergency kit of antiretroviral triple therapy for three days. At the beginning and every three months thereafter a structured interview was conducted assessing sexual risk behavior and attitude in the interval. In the case of an HIV exposure, the decision to start HIV-PEP was reviewed and a joint decision whether to continue or discontinue the medication was reached. Study participants were followed over a period of one year.
Results: During the study period four HIV-PEP cases occured; no seroconversion occured. The time between exposure and start of medication was less than one hour in all four cases. The indication to start HIV-PEP was made in accordance with the Guidelines in all four cases. More than half of the study participants had never had a high risk sexual HIV-exposure (definded as unprotected sex or condom failure) before the start of the study. In 5 of 21 evaluable cases the number of risky exposures decreased after availability of the emergency kit, in 2 it increased. A clear difference in sexual behavior was observed between couples that were aware of their serodiscordance at the beginning of the partnership and couples that were unaware or
presumably both seronegative at that time. Especially in these latter couples a previously unsatisfied demand for counseling was noted.
Conclusion: The issuing of an emergency kit of antiretroviral drugs in combination with counseling enables HIV-seronegative partners to initiate HIV-PEP without delay while not increasing risk behavior in serodiscordant couples.
|
