Longitudinal Trends in HIV Nonoccupational Postexposure Prophylaxis Use at a Boston Community Health Center Between 1997 and 2013

Jain, Sachin H.; Oldenburg, Catherine E.; Mimiaga, Matthew J.; Mayer, Kenneth H.

doi:10.1097/qai.0000000000000403

Cited by 21 publications

(18 citation statements)

References 36 publications

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“…We found that only 6.5% of all persons repetitively showed up at the ER for PEP. This number is substantially lower than the 20% reported in previous studies [32][33][34][35] and, thus, suggests that PEP is unlikely to promote higher sexual risk behavior, which is consistent with a report by Martin et al [36]. However, persons with high-risk sexual behavior, presenting repetitively for PEP, most likely would be the ideal candidates for HIV PrEP.…”

Section: A C C E P T E Dsupporting

confidence: 84%

Prescription of Postexposure Prophylaxis for HIV-1 in the Emergency Room: Correct Transmission Risk Assessment Remains Challenging

Marzel

Heinrich

Schilliger

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Section: A C C E P T E Dsupporting

confidence: 84%

Prescription of Postexposure Prophylaxis for HIV-1 in the Emergency Room: Correct Transmission Risk Assessment Remains Challenging

Marzel

Heinrich

Schilliger

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…As we learn lessons from “real-world” experiences about how best to implement PEP and PrEP, the transition from PEP to PrEP will also require active investigation, since some patients who receive PEP may engage in recurrent high-risk behaviors [107, 108] and may therefore benefit from ongoing chemoprophylaxis to prevent HIV acquisition. Unfortunately, the awareness of NPEP has been limited even among high-risk MSM, as demonstrated by several studies [109–111].…”

Section: Pre-exposure Prophylaxis (Prep)mentioning

confidence: 99%

Antiretrovirals for Primary HIV Prevention: the Current Status of Pre- and Post-exposure Prophylaxis

2015

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In light of the 2 million HIV infections that occur globally each year, there is a need to optimize strategies that integrate biomedical and behavioral approaches to HIV prevention. Post-exposure prophylaxis (PEP) immediately after acute high-risk exposures and pre-exposure prophylaxis (PrEP) for those who engage in recurrent high-risk behaviors are promising bio-behavioral approaches to decreasing HIV transmission. Guidelines have recommended PEP for occupational and non-occupational exposures for over 15 years, but uptake of PEP has been limited, partly as a result of insufficient awareness of this intervention among persons at highest risk for acquiring HIV. However, since the publication of large randomized clinical trials demonstrating the efficacy of PrEP, and the dissemination of guidelines endorsing its use, there is a renewed focus on bio-behavioral prevention. Numerous studies have recently assessed the acceptability of bio-behavioral prevention programs among diverse populations or described experiences implementing these programs in “real-world” settings. As research and clinical data informing optimal utilization of PEP and PrEP are rapidly accumulating, this review provides a timely summary of recent progress in bio-behavioral prevention. By contextualizing the most noteworthy recent findings regarding PEP and PrEP, this review seeks to inform successful implementation of these promising prevention approaches.

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“…More recently, newer medications have been developed that are better tolerated. The use of tenofovir disoproxil fumarate (TDF) instead of AZT as part of a PEP regimen has been associated improved tolerability and higher completion rates, offering the promise of fewer seroconversions (17, 18). …”

Section: Introductionmentioning

confidence: 99%

Optimal HIV Postexposure Prophylaxis Regimen Completion With Single Tablet Daily Elvitegravir/Cobicistat/Tenofovir Disoproxil Fumarate/Emtricitabine Compared With More Frequent Dosing Regimens

Mayer

Jones

Oldenburg

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Structure The study evaluated elvitegravir/cobicistat/tenofovir disiproxil fumarate(TDF)/emtricitabine(FTC) (“Quad pill”) for post-exposure prophylaxis (PEP). Background HIV-exposed individuals may benefit from PEP, but completion rates have been suboptimal because of regimen complexity and side effects. Newer antiretroviral combinations co-formulated as single daily pills may optimize PEP adherence. Setting One hundred HIV-uninfected individuals who presented to a Boston community health center after an acute HIV sexual exposure were enrolled and initiated PEP with the daily, single pill combination Quad pill for a 28-day course. Methods Side effects and medication completion rates from study participants were compared to historical controls who had used PEP regimens consisting of TDF/FTC daily and raltegravir twice daily, or earlier regimens of twice daily zidovudine (AZT)/lamivudine (3TC) and a protease inhibitor, using chi-square tests for independence. Results Of the 100 participants who initiated the Quad pill for PEP after a high risk sexual exposure, 71% completed the 28 day Quad pill regimen, which was significantly greater than historical controls who used TDF/FTC and raltegravir (57%, p <0.05) or AZT/3TC plus a protease inhibitor (39%, p < 0.001). The most common side effects reported by Quad pill users were: abdominal discomfort or pain, gas or bloating (42%), diarrhea (38%), fatigue (28%), nausea or vomiting (28%), headache (14%), or dizziness or lightheadedness (6%). Most symptoms were mild, limited, and did not result in medication discontinuation. No participants became HIV-infected. Conclusions Fixed dose combination elvitegravir/cobicistat/TDF/FTC was safe and well-tolerated for PEP, with higher regimen completion rates than more frequently dosed PEP regimens.

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Longitudinal Trends in HIV Nonoccupational Postexposure Prophylaxis Use at a Boston Community Health Center Between 1997 and 2013

Cited by 21 publications

References 36 publications

Prescription of Postexposure Prophylaxis for HIV-1 in the Emergency Room: Correct Transmission Risk Assessment Remains Challenging

Prescription of Postexposure Prophylaxis for HIV-1 in the Emergency Room: Correct Transmission Risk Assessment Remains Challenging

Antiretrovirals for Primary HIV Prevention: the Current Status of Pre- and Post-exposure Prophylaxis

Optimal HIV Postexposure Prophylaxis Regimen Completion With Single Tablet Daily Elvitegravir/Cobicistat/Tenofovir Disoproxil Fumarate/Emtricitabine Compared With More Frequent Dosing Regimens

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