Hepatitis C Virus Postexposure Prophylaxis in the Healthcare Worker: Why Direct-Acting Antivirals Don't Change a Thing.
Currently, 380 000-400 000 occupational exposures to blood-borne pathogens occur annually in the United States. The management for occupational HIV or hepatitis B virus exposures includes postexposure prophylaxis (PEP) when necessary; however, PEP is not recommended for hepatitis C virus (HCV) exposures. Recent approval of HCV direct-acting antivirals (DAAs) has renewed discussions as to whether these therapies could be used to prevent infection after exposure. There are no published studies addressing this question, but the prescribing of DAAs for PEP has been reported. We will discuss the differences in transmission of the 3 most common blood-borne pathogens, the natural history of early HCV infection, and the scientific rationale for PEP. In particular, we will discuss how the low feasibility of conducting an adequately powered clinical trial of DAA use for PEP and the low cost-effectiveness of such an intervention is not supportive of targeting limited resources for such use.
Duke Clinical Research Institute.|Duke University School of Medicine, Durham, North Carolina.
Susanna
S
Naggie
Emory University School of Medicine, Atlanta, Georgia.
David P
DP
Holland
Johns Hopkins School of Medicine, Baltimore, Maryland.
Mark S
MS
Sulkowski
Johns Hopkins School of Medicine, Baltimore, Maryland.
David L
DL
Thomas
D000208:Acute Disease; D000998:Antiviral Agents / Q000627:therapeutic use*; D018890:Chemoprevention / Q000379:methods; D002908:Chronic Disease; D003365:Costs and Cost Analysis; D006282:Health Personnel; D016174:Hepacivirus / Q000502:physiology; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D016273:Occupational Exposure / Q000517:prevention & control; D056990:Post-Exposure Prophylaxis / Q000379:methods; D018570:Risk Assessment; D016896:Treatment Outcome
D000998:Antiviral Agents
cost-analysis; direct acting antivirals; hepatitis C virus; occupational exposure; postexposure prophylaxis
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