AEGiS-14IAC: Management of post-exposure prophylaxis after occupational exposure to HIV in healthcare workers in Europe.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Management of post-exposure prophylaxis after occupational exposure to HIV in healthcare workers in Europe.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. LbOr01A)

Cicalini S, Antunes F, Balslev U, Bernasconi E, Boaventura JL, Campins M, Evans B, Francioli P, Genasi F, Larsen C, Lot F, Lunding S, Marcus U, Pereira A, Schonwald S, Thomas T, De Carli G, Ippolito G, Puro V
INMI Spallanzani, Rome, Italy

BACKGROUND: Occupational post-exposure prophylaxis (OPEP) against HIV represents the standard of care in exposed healthcare workers (HCW), but no general consensus exists on some issues.

METHODS: On September 2001, the European Commission funded a project co-ordinated by Italy (I), to evaluate and standardize the management of OPEP in Europe. Croatia (C), Denmark (DK), United Kingdom (UK), France (F), Germany (D), Portugal (P), Spain (E), Switzerland (CH), participate in the project. Existing guidelines (GL) were collected; policies, procedures and data regarding OPEP were investigated through a questionnaire and discussed with representatives of participating Countries.

RESULTS: All Countries have National or hospital (P, C) GL that recommend starting 4-week PEP as soon as possible, with 3 drugs regardless of risk assessment in UK, CH, F, D, DK, or only in high risk exposure in C, E, I, P. The interval after which PEP is discouraged ranges from 24 h (I, DK) to 72 h (CH, D, E, P), allowing 14d for high risk exposures (UK, P). HIV testing schedule differs in timing, with HIV-Ag/RNA performed only in F. PEP is available in all (F, UK) or larger (P, E, CH, C) hospitals, or in hospitals with an infectious diseases department (D, DK, I). PEP collected cases approximate 1000/year [data from the National Registry (CH, DK, F, I, UK); from a network of hospitals (E), or a University hospital (C); not available (P, D)]. Acceptance rates varied from 28% (E) to 73% (UK); the proportion of HCW who completed PEP ranged between 25% (UK) to 84% (F). A significant number of PEP is started after exposure to a source who later tested HIV negative, lasting a mean of 1-4 days. Rapid HIV testing is rarely used.

CONCLUSIONS: OPEP is widely prescribed in EU Countries, though differing in several aspects. Uniform GL should be developed to implement a rapid risk assessment, optimize availability and management, and minimize unnecessary treatments and related toxicity and costs.

Keywords: AEGIS, Health Personnel, HIV Infections, Occupational Exposure, HIV Seropositivity, Europe, Drug Therapy, Combination, Switzerland, Spain, Great Britain, France, Italy, Portugal, Germany, Croatia, Denmark, Greece, prevention & control, Poisoning, therapy, organization & administration, drug therapy

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LbOr01A