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

Abstract

We found that 22% of PEP decisions were risk discordant because of exposed person's request, incorrect estimation of the sexual transmission risk by the physician, or exposed person's refusal to accept PEP. Emergency physicians may benefit from specialized risk assessment training and patients from education in HIV transmission risk awareness.

To prescribe, or not to prescribe: decision making in HIV‐1 post‐exposure prophylaxis

“…Accordingly, Marzel et al . showed that 12% of prescriptions in a cohort with 1051 PEP requests not in line with guidelines were made at the exposed person's request .…”

“…However, it is conceivable that emotional stress had an impact in even more consultations, but was not documented by the physician. Accordingly, Marzel et al showed that 12% of prescriptions in a cohort with 1051 PEP requests not in line with guidelines were made at the exposed person's request [7].…”

“…Interestingly, it has been shown that decision making in PEP prescription is influenced by the expertise of the physician in charge and the exposed person's demand . As PEP is a prevention method that is utilized if other prevention methods were not used or failed, patients often present at the clinic in a state of acute anxiety, in fear of potentially being infected with HIV . Evidently, this situation often affects decision making and could lead to prescriptions that are not according to guidelines.…”

Data linkage to evaluate the long-term risk of HIV infection in individuals seeking post-exposure prophylaxis

“…This is a retrospective study involving data linkage between 3 pre-existing databases, i.e., the PEP-USZ database, the ZPHI and the SHCS. The PEP-USZ database has been described elsewhere 32 : in brief, it consists of data from 975 individuals who sought non-occupational PEP prescription at the USZ between 2007 and 2013 (corresponding to 1051 consultations). For each PEP consultation occurring within this timeframe, data routinely collected by the attending physician were extracted from the USZ electronic patient record system and entered in the PEP-USZ database (Supplementary Note 1).…”

“…Adherence to PEP (i.e., prescribed but not taken, prescribed but inadequately taken) was used to assess the plausibility of transmission events. All risk factors and confounders were predefined and based on data availability from the pre-existing PEP-USZ database 32 . Only factors related to individuals seeking PEP (as opposed to the episodes triggering PEP consultation) were considered.…”