Following the US Centers for Disease Control (CDC) issuing specific recommendations concerning occupational PEP, it was suggested that PEP should also be offered to people with unanticipated sexual or drug-related exposures.

A recent CDC statement on the management of non-occupational exposures to HIV concluded that since no data exist regarding the efficacy of PEP for non-occupational exposure, recommendations for or against its use cannot yet be made. 

In order to collect needed information, the US National non-occupational HIV post-exposure prophylaxis registry was created back in 1999. Data presented at XIV International AIDS Conference in Barcelona in July 2002 showed 219 cases in the registry up to March 2001.

US clinicians are invited to provide information on potential HIV exposure within 60 days of the event occurring, so long as the exposure was sexual, or involved drug use or some other known HIV transmission pathway- for example needlestick injury, so long as it did not occur in the occupational setting.

The objectives of the registry are to;

• determine the characteristics of the exposures for which PEP is prescribed.
• assess the completion rate of prescribed PEP regimens, and to assess the impact of side effects and adverse events on early discontinuations.
• identify differences in PEP practice in different clinical settings (i.e. emergency rooms, private practice).
• evaluate and compare HIV infection rates between those who sustain exposures and are treated with PEP and those who are exposed but untreated.
• monitor the occurrence of acute retroviral syndrome.
• monitor repeat use of PEP by those receiving an initial course reported to the registry.

The initial report will ascertain patient and provider demographic characteristics; the nature, extent, and timing of the reported exposure; HIV status and risk behaviours of the reported source (if known); whether antiretroviral treatment was offered and accepted; and what treatment (if any) was given.

Follow-up reporting will provide additional information:

• at 4-6 weeks

At 4-6 weeks following the initial visit, data will be collected to document the HIV status of the patient at the time of exposure, whether treatment (if given) was completed, altered, or discontinued before 28 days, and the HIV status of the patient 4-6 weeks after potential exposure. Information on side-effects and adverse effects of therapy, and any symptoms of acute retroviral syndrome will also be collected:

• at 6 and 12 months

Information collected at the 6-month and 12-month follow-up will include information about HIV test results and HIV exposures reported since the 4-6 -week follow-up visit, and whether or not an additional course of PEP was given.

References

HIV Post Exposure Prophylaxis: Guidance from the UK Chief Medical Officers' Expert Advisory Group on AIDS. Department of Health. July 2000.

Easterbrook P et al. Post-exposure prophylaxis for occupational and sexual exposures to HIV: experience in a London hospital. Twelfth World AIDS Conference, Geneva, abstract 33176, 1998.

Kahn J et al. Feasibility of post-exposure prophylaxis (PEP) against human immunodeficiency virus infection after sexual or injection drug use exposure: The San Francisco PEP study. Journal of Infectious Diseases 183: 707-714, 2001.

Katz M et al. Postexposure treatment of people exposed to the human immunodeficiency virus through sexual contact or injection-drug use. New England Journal of Medicine 336: 1097-1100, 1997.

Lurie P et al. Postexposure prophylaxis after nonoccupational HIV exposure: clinical, ethical and policy considerations. Journal of the American Medical Association 280: 1769-1773, 1998.

Mauss S et al. Rapid development of central adiposity after postexposure prophylaxis with antiretroviral drugs: a proof of principle? AIDS 17: 944 – 955, 2003.

Opio G et al. Post-sexual exposure prophylaxis with HAART after sexual assault. Twelfth World AIDS Conference, Geneva, abstract 33174, 1998.

Stephenson J. PEP talk: treating nonoccupational HIV exposure JAMA 289: 287-288, 2003.

Torres R et al. Preliminary report on nonoccupational post-exposure prophylaxis utilizing an NNRTI/NRTI regimen. Thirteenth International AIDS Conference, Durban, abstract TuPeB3204, 2000.