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Occupational exposure to HIV: experience at a tertiary care center
R B Swotinsky1, K A Steger, C Sulis
1Department of Medicine, Boston University School of Medicine, Mass, USA.
Journal of Occupational and Environmental Medicine
|January 1, 1999
Summary
Combination antiretroviral therapy for human immunodeficiency virus (HIV) postexposure prophylaxis is frequently associated with side effects, leading to treatment non-completion. Challenges include timely testing, staff education, and monitoring for optimal HIV prevention.
Area of Science:
- Occupational Health
- Infectious Diseases
- Pharmacology
Background:
- Occupational exposure to human immunodeficiency virus (HIV) necessitates postexposure prophylaxis (PEP).
- Combination antiretroviral therapy (cART) is the standard for HIV PEP.
- Evaluating the real-world effectiveness and tolerability of cART for HIV PEP is crucial for healthcare workers.
Purpose of the Study:
- To assess the experience of a hospital-based occupational health clinic with cART for HIV PEP.
- To identify the incidence and types of side effects associated with HIV PEP regimens.
- To evaluate the completion rates and costs of HIV PEP.
Main Methods:
- Retrospective review of 68 healthcare workers who initiated HIV PEP over 12 months.
- Analysis of PEP regimens used: zidovudine/lamivudine (n=23) and zidovudine/lamivudine/indinavir (n=45).
- Documentation of reported side effects, treatment completion, and associated costs.
Main Results:
- 75% (51/68) of workers reported at least one side effect.
- Higher incidence of side effects observed with three-drug regimens compared to two-drug regimens.
- Many workers did not complete the 28-day PEP regimen due to side effects.
- Mean cost per exposure was $669.
Conclusions:
- Side effects are a significant barrier to completing cART for HIV PEP, impacting adherence.
- Implementation challenges include timely source testing, staff education, and vigilant monitoring of PEP.
- Consideration of alternative regimens for workers intolerant to standard cART is warranted to improve HIV prevention outcomes.