AEGiS-14IAC: More practicable post-exposure prophylaxis (PEP) regimens against HIV infection for african health care workers (HCW) explored by decision analysis.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

More practicable post-exposure prophylaxis (PEP) regimens against HIV infection for african health care workers (HCW) explored by decision analysis.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. MoOrD1110)

Freers J, Kellett J, Mayanja-Kizza H
Makerere University, Kampala, Uganda

BACKGROUND: Frequency of nosocomial exposures, side effects and cumulative cost of ARV's make recommended PEP regimens impractical for HCW in Africa. Non-occupational risks of HIV appear to make PEP pointless for the extra risk run by HCW in Africa. Nevirapine with its rapid absorption, long half life and lack of side effects if given for a short time is effective in preventing HIV mother to child transmission suggesting suitability for PEP. The validity of the aforesaid was assessed using a mathematical decision analysis model.

METHODS: Data were obtained from MEDLINE searches and interviews with physicians from Mulago Hospital, Kampala, Uganda. Physicians between 25 and 55 years reported 4 occupational exposures per year with an average infection risk of 0.5%. Non-occupational HIV infection was estimated to be 1% per person / year.

RESULTS: Zidovudine (ZDV) PEP was predicted to save 47 days of life if given for a single exposure. The hypothetically 100% effective three-drug regimen was predicted to gain 11 additional days. Repeated administrations of ZDV over a professional lifetime were predicted to gain 5.54 years of life whereas the triple therapy gained an additional 1.75 years. Since drug side effects will prevent 30% of PEP-candidates from completing the full course, even triple-therapy PEP is unlikely be 100% effective. A hypothetical side-effect free drug was modelled through all levels of effectiveness. Even if effective in only 20%, its repeated administration over a professional lifetime could gain 1.2 years of extra life.

CONCLUSION: This analysis details why currently recommended PEP regimens are impractical for physicians in Africa. It points out that a side effect free PEP would be practical and beneficial, even if less effective than current regimens. Whether or not alternative potential PEP agents should be offered to physicians in Africa without clinical trial evidence of efficacy is debated.

Keywords: AEGIS, HIV Infections, Health Personnel, Zidovudine, Nevirapine, Drug Therapy, Combination, Occupational Exposure, Africa, Uganda, Child, Human, prevention & control, therapy, drug therapy

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MoOrD1110