[Non-occupational post-exposure HIV prophylaxis. Knowledge and practices among physicians and groups with risk behavior]

Although occupational post-exposure HIV prophylaxis is widely admitted and used, the non-occupational post-exposure prophylaxis (NONOPEP) is controversial. Prevention of mother-to-child HIV transmission, experimental studies in animal models and retrospective studies in health workers, along with biological plausibility, would justify the use of NONOPEP in certain circumstances. Our objectives were: 1) To review the existence of recommendations; 2) To describe the attitudes, knowledge and practices of the professionals involved in the attention of non-occupational exposures to HIV; 3) To describe the attitudes and knowledge on such a prophylaxis by people with risk behaviours (homosexual men and intravenous drug users (IDU)); and 4) To describe the NONOPEP-related responses of telephone services of public attention on AIDS.

Descriptive study by means of a survey of each defined target population between September 1999 and July 2000, using self-administered questionnaires and personal interviews. Structured and simulated interviews were used to survey the telephone services.

To date, no official recommendations exist. 84% (97/116) of consulted doctors have taken care of some of non-occupational accidental exposure to HIV over the last six months. 77% (75/97) have prescribed NONOPEP, and 76% of doctors prescribing NONOPEP (57/75) have used the 1998 CDC recommendations for occupational exposures. Most frequent observed cases were related to needle sticks in the street and preservative breakage. The assessment of certain risk factors and therapeutic performance in cases of intermediate risk showed discrepancies among doctors. 41% (103/252) among homosexuals and 2% (3/160) among IDU on treatment know the NONOPEP. 15% (15/98) and 98% (70/118) respectively would take less prevention to avoid HIV infection if they took the NONOPEP. It was mentioned the possibility of NONOPEP in 20% (12/59) of calls to the information telephone services on AIDS.

HIV risk accidents susceptible of NONOPEP are relatively frequent. Without forgetting the greater importance of primary prevention, it is advisable to reach and agreement on homogeneous recommendations. It is also advisable to draw up a surveillance system to evaluate the application and eventually the effectiveness of these recommendations.