[Post-exposure prophylaxis of HIV infection in out-patient clinic of hospital for infectious diseases in Warsaw in 2001-2002].
Post-exposure prophylaxis (PEP) after exposure to potentially infectious material remains one of the most important elements of HIV prevention. In some cases it requires antiretroviral drugs administration, which might cause serious side effects. The following analysis was performed to identify adverse events of antiretroviral therapy in PEP as well as to evaluate patients adherence to consultations and tests schedule. Data were collected from standard forms filled in by physicians during consultation visits in 2001-2002. To identify HIV infection HIV Duo-quick test (BioMerieux, Vidas) was performed on the first visit, then after 2 weeks, 6 weeks, 3 months and 6 months. Among 177 patients (pts) there were 79 exposures in health care workers (HCWs), 98 in non-HCWs. In 70 of HCWs exposure was by needle-stick injury (NSI), in 3 cases by other medical instrument. In non-HCWs 88 cases exposure was by NSI and in three cases by human's bite. Only one HIV test was performed in 25 cases (31,6%) in HCWs group vs 16 pts (16,3%) in non-HCWs group (p=0.016). Twelve HCWs (15,2%) and 9 non-HCWs did not come back for the test result (p=0,2). The mean time from exposure to initiating PEP was 6 hours 48 min in HCWs vs 7 hours 16 min in non-HCWs group (p=0,77). Except 2 cases of d4T+ddl in HCWs group all others were AZT+3TC (63 HCWs and 91 non-HCWs). Three drug regimen with PI as third drug (indinavir or nelfinavir) was used in 14 cases of HCWs and 7 non-HCWs. Side effects (SE) were observed in 25 HCWs (31,6%) vs 37 non-HCWs (37,8%) (p=0,467), leading to PEP discontinuation in 11 vs 4 respectively (p=0,0028). PEP was continued despite SE in 14 HCWs vs 33 non-HCWs (p=0,007). There was no post-exposure HIV infection. Adherence to consultations and tests schedule was better in non-HCWs. Although the risk of infection was potentially lower in that group pts showed up and tested more regularly, less pts did not collect the test result. Even though tolerability in terms of SE frequency was slightly better in HCWs group, non-HCWs were more willing to take ARV for four weeks even in presence of SE. More of non-HCWs followed full drug prophylaxis.
Poradnia Profilaktyczno-Lecznicza Wojewódzki Szpital Zakaźny ul. Leszno 17, 01-199 Warszawa. jkowalska@cdit-aids.med.pl
Justyna Dominika
JD
Kowalska
Ewa
E
Firlag-Burkacka
Małgorzata
M
Niezabitowska
Elzbieta
E
Bakowska
Anna
A
Ignatowska
Piotr
P
Pulik
Andrzej
A
Horban
D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000009:adverse effects*; D002648:Child; D005260:Female; D015658:HIV Infections / Q000209:etiology / Q000517:prevention & control* / Q000635:transmission; D006282:Health Personnel; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional; D008297:Male; D008875:Middle Aged; D016602:Needlestick Injuries / Q000150:complications; D009784:Occupational Diseases / Q000517:prevention & control*; D016273:Occupational Exposure; D010349:Patient Compliance; D011044:Poland; D012189:Retrospective Studies
D019380:Anti-HIV Agents