Sexual exposure to HIV infection: is there a role for emergency prophylaxis?

Knowledge and attitudes of nurses working in sexual health clinics in the United Kingdom toward post-sexual exposure prophylaxis for HIV infection

The use of anti-human immunodeficiency virus (HIV) drugs after occupational exposure to HIV is a proven method of preventing some HIV infections. There is anecdotal evidence that this treatment is being used to treat recently exposed sexual contacts of HIV infection, known as non-occupational post-exposure prophylaxis (NONOPEP). This raises the issues of the impact of such treatment on sexual behavior and public health. Six hundred questionnaires were distributed to nurses working in sexual health clinics. Four hundred and six (67%) were returned. Questionnaires contained items related to awareness of HIV NONOPEP and items included attitudes related to its use. Seventy two percent of respondents were aware of HIV NONOPEP, and 17% had experience of its use in their clinic. Twenty one percent of respondents indicated that their clinic had a specific HIV NONOPEP policy. In relation to attitudes, practitioners were more positive of NONOPEP in relation to an HIV exposure within a long-term relationship than exposure within a casual relationship, indicating that the mode of HIV exposure was a factor in the justification of NONOPEP. Practitioners seemed to support the notion that HIV NONOPEP use in a casual exposure may increase the likelihood of unsafe sexual practice; however, practitioners with experience were less likely to express this view. It is suggested that an informed debate and NONOPEP policy development within all sexual health clinics will militate against judgmental views affecting access and care.

Nonoccupational HIV postexposure prophylaxis: a new role for the emergency department

Despite numerous primary prevention campaigns, new cases of HIV infection are occurring at high rates. Postexposure prophylaxis (PEP) after possible HIV exposures from sexual encounters or injection drug use may prove to be a worthwhile means of reducing HIV infection. Although there are no studies that directly demonstrate its efficacy, indirect support comes from animal and human studies. Multiple animal studies have shown that antiretroviral medications can reduce simian immunodeficiency virus infections if given early and for a prolonged period. A study of health care workers suggests that zidovudine taken after needlestick injuries can dramatically reduce HIV seroconversion. Zidovudine and nevirapine use recently showed great reductions in perinatal HIV transmission. Studies of dendritic and T-cell processing of simian immunodeficiency virus and HIV indicate that antiretroviral medications taken soon after a viral exposure may terminate viral replication. Regimens of 2 or 3 antiretroviral medications have been suggested as prophylactic measures after certain exposures. Even though limited experience exists with these populations, HIV PEP is most likely safe in pregnancy and for children. Emergency departments are encouraged to anticipate the probable demands for nonoccupational HIV PEP by establishing protocols for its rapid provision and ensuring proper follow-up care.

Postexposure to HIV prophylaxis

Since the reports of an international case-control study during the period 1995-1997, further evidence has accumulated supporting the use of postexposure therapy with antiretrovirals. This includes evidence from vertical transmission studies with both zidovudine and nevirapine, and animal model data. Guidelines have been developed and revised for occupational postexposure prophylaxis provision, but there remains considerable debate over postexposure prophylaxis for nonoccupational (predominantly sexual) exposures.