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Non-occupational postexposure prophylaxis for HIV: a systematic review
1Southampton Health Technology Assessments Centre, Wessex Institute for Health Research and Development, University of Southampton, Southampton, UK.
Health Technology Assessment (Winchester, England)
|February 25, 2009
Summary
Limited evidence exists for the clinical effectiveness of non-occupational post-exposure prophylaxis (PEP) for HIV. However, HIV PEP may be cost-effective for specific high-risk groups, though results require cautious interpretation due to data limitations.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Health Economics
Background:
- Non-occupational post-exposure prophylaxis (PEP) is a strategy to prevent HIV infection after potential exposure.
- Evidence regarding the clinical effectiveness and cost-effectiveness of non-occupational PEP is crucial for public health policy.
- Previous reviews have highlighted the need for robust data on PEP's impact in diverse risk groups.
Purpose of the Study:
- To systematically review the available evidence on the clinical effectiveness of non-occupational PEP for HIV.
- To evaluate the cost-effectiveness of non-occupational PEP across various risk behaviors and demographic groups.
- To synthesize findings to inform clinical practice and policy regarding HIV prevention.
Main Methods:
- A comprehensive literature search was conducted across eleven electronic databases up to December 2007.
- Included studies underwent rigorous assessment, data extraction, and quality evaluation.
- A narrative synthesis approach was employed to integrate findings from all eligible studies.
Main Results:
- Only one weak-quality clinical effectiveness study was identified, showing no significant difference in seroincidence between PEP and non-PEP groups.
- Four economic evaluations suggested that non-occupational PEP could be cost-saving or cost-effective for specific high-risk populations, including men who have sex with men and intravenous drug users.
- Adverse events, primarily nausea and fatigue, were common, with higher rates in triple therapy regimens, impacting treatment completion.
Conclusions:
- Insufficient evidence prevents definitive conclusions on the clinical effectiveness of non-occupational PEP for HIV.
- Non-occupational PEP demonstrates potential cost-effectiveness in certain subgroups, but findings should be interpreted cautiously due to methodological limitations and data constraints.
- Further high-quality research is needed to establish the definitive clinical effectiveness and optimize the use of non-occupational PEP.
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