Concordance of emergency department physicians’ decisions on HIV post-exposure prophylaxis with national guidelines: results from a retrospective cohort study

Abstract

Background Post-exposure prophylaxis (PEP) is an effective tool to prevent infection with HIV. Patients seeking PEP after potential HIV exposure usually present to the emergency department (ED). Our study sought to determine the concordance of ED physicians’ decisions on HIV-PEP with national guidelines (primary objective) and to assess the clinical relevance of drug–drug interactions (DDIs) between the HIV-PEP regimen and patients’ concomitant medication (secondary objective). Methods We conducted a retrospective cohort study at the ED of Hannover Medical School, Germany. Between 1 January 2018 and 31 December 2019, 113 of 11 246 screened patients presented to the ED after potential HIV exposure and were enrolled in the study. Results The median age of the patients (82.3% male) was 30 y (IQR 25–35.5), 85.8% of potential HIV exposures were characterised as sexual and 85.0% presented within 72 h. ED physicians’ decisions on HIV-PEP were concordant with national guidelines in 93.8%. No clinically relevant DDIs were detected. Conclusions ED physicians’ decisions on HIV-PEP were highly concordant with national guidelines. Approximately 1% of patient presentations to the ED were related to HIV exposure; therefore, training ED physicians on HIV transmission risk assessment and indications/contraindications for HIV-PEP is paramount.

Missed Opportunities: A Narrative Review on Why Nonoccupational Postexposure Prophylaxis for HIV Is Underutilized

“…Those studies included 38 355 individuals, with 37 040 (96.6%) classified as eligible for PEP, among whom 23 511 (63.5%) were prescribed PEP. Importantly, 2 of those studies included health care exposures (n = 491) that could not be distinguished from other exposures [ 17 , 27 ]. Additionally, 3 of those studies included patients also presenting to nonacute settings (primary care, obstetrics clinics, HIV specialty clinics, and anonymous screening centers), but those data could not be disaggregated.…”

“…Additionally, 3 of those studies included patients also presenting to nonacute settings (primary care, obstetrics clinics, HIV specialty clinics, and anonymous screening centers), but those data could not be disaggregated. The risk behaviors that constituted PEP eligibility in acute care settings were predominantly consensual sex (with a partner with HIV or unknown HIV status) and sexual assault, while 1 study included patients exposed via soiled needles, assault injuries, bites, scratches, and saliva [ 22 ] and 1 study included sex workers (n = 2) [ 27 ]. One study did not report the risk behaviors [ 24 ].…”