title: Significant intolerability of efavirenz in HIV occupational postexposure prophylaxis.
abstract: BACKGROUND
  Completion of human immunodeficiency virus (HIV) occupational postexposure prophylaxis (PEP) is important for successful prophylaxis.
  
  
  OBJECTIVE
  To determine factors associated with failure to complete the four-week HIV PEP.
  
  
  METHODS
  A retrospective study was conducted among healthcare workers (HCWs) accidentally exposed to blood or body fluids of patients at the Bamrasnaradura Infectious Diseases Institute, Thailand, between March 1996 and June 2014. Logistic regression analysis was used to determine factors associated with failure to complete the four-week HIV PEP.
  
  
  RESULTS
  In total, 225 exposure episodes were reported. The mean age of HCWs was 33.1 (standard deviation 9.9) years, and 189 (84%) were female. Nurses (43%) were exposed most frequently. The HIV status of the source was defined in 149 (66%) episodes, and 101 (68%) of these were positive. Of 225 exposures, PEP was prescribed in 155 (69%) cases, with intentional discontinuation in 26 cases. Ninety-one of 129 (71%) HCWs completed the four-week regimen. Multi-variate analysis showed that a regimen of two nucleotide reverse transcriptase inhibitors (NRTI) + efavirenz (EFV) was the only significant factor associated with non-completion of the four-week course (odds ratio 37.8, 95% confidence interval 4.2-342.3; P < 0.01). Other factors including age, sex, staff position, status of the source and other PEP regimens were not associated with non-completion of the four-week course (P > 0.05). None of the HCWs were documented to have HIV seroconversion.
  
  
  CONCLUSIONS
  A regimen of two NRTIs + EFV was significantly associated with premature discontinuation of occupational PEP. This regimen should not be used for HIV prophylaxis following occupational exposure.
authors.affiliation: Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand. Electronic address: surasakwiboon@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Wiboonchutikul
authors.affiliation: Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand.
authors.forename: V
authors.initials: V
authors.lastname: Thientong
authors.affiliation: Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand.
authors.forename: P
authors.initials: P
authors.lastname: Suttha
authors.affiliation: Bangkok Hospital, Bangkok, Thailand.
authors.forename: B
authors.initials: B
authors.lastname: Kowadisaiburana
authors.affiliation: Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand.
authors.forename: W
authors.initials: W
authors.lastname: Manosuthi
mesh_terms: D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects*; D048588:Benzoxazines / Q000008:administration & dosage / Q000009:adverse effects*; D003521:Cyclopropanes; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006282:Health Personnel; D006801:Humans; D008297:Male; D055118:Medication Adherence; D016273:Occupational Exposure; D056990:Post-Exposure Prophylaxis / Q000379:methods*; D012189:Retrospective Studies; D013785:Thailand
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; C098320:efavirenz
keywords: Efavirenz; HIV infection; Occupational exposure; Postexposure prophylaxis; Tolerability