Postexposure Prophylaxis for HIV Infection

University of California at Los Angeles Center for Clinical AIDS Research and Education and the David Geffen School of Medicine at UCLA, Los Angeles, CA 90035, USA.
New England Journal of Medicine (Impact Factor: 54.42). 10/2009; 361(18):1768-75. DOI: 10.1056/NEJMcp0904189
Source: PubMed

ABSTRACT A 24-year-old man presents to an outpatient clinic, reporting that 36 hours previously he had receptive anal intercourse without the use of a condom with an anonymous male partner who was known to have had sex with other men. The patient is known to the clinical practice and has had several negative tests for human immunodeficiency virus (HIV) infection, most recently 6 months previously. How should he be evaluated and treated?

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    ABSTRACT: Background. Stimulant-using men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV) acquisition. Contingency Management (CM) is a robust substance abuse intervention that provides voucher-based incentives for stimulant-use abstinence. Methods. We conducted a randomized controlled trial of CM with postexposure prophylaxis (PEP) among stimulant-using MSM. Participants were randomized to CM or a noncontingent "yoked" control (NCYC) intervention and observed prospectively. Generalized linear models were used to estimate the effect of CM on PEP course completion, medication adherence, stimulant use, and sexual risk behaviors. Results. At a single site in Los Angeles, 140 MSM were randomized to CM (n = 70) or NCYC (n = 70). Participants were 37% Caucasian, 37% African American, and 18% Latino. Mean age was 36.8 (standard deviation = 10.2) years. Forty participants (29%) initiated PEP after a high-risk sexual exposure, with a mean exposure-to-PEP time of 32.9 hours. PEP course completion was greater in the CM group vs the NCYC group (adjusted odds ratio [AOR] 7.2; 95% confidence interval {CI}, 1.1-47.9), with a trend towards improved medication adherence in the CM group (AOR, 4.3; 95% CI, 0.9-21.9). Conclusions. CM facilitated reduced stimulant use and increased rates of PEP course completion, and we observed a trend toward improved adherence. Participants in the CM group reported greater reductions in stimulant use and fewer acts of condomless anal intercourse than the control group. This novel application of CM indicated the usefulness of combining a CM intervention with PEP to produce a synergistic HIV prevention strategy that may reduce substance use and sexual risk behaviors while improving PEP parameters.
    01/2015; 2(1):ofu114. DOI:10.1093/ofid/ofu114
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    ABSTRACT: Background: Healthcare providers are in constant risk of exposure to Human Immunodeficiency Virus (HIV) during their routine practice. This makes it paramount to evaluate their knowledge, attitude and practice of Post- Exposure Prophylaxis (PEP). Since this will determine their likely line of action if exposed to HIV. Therefore, this study aimed to determine their level of knowledge, altitude and practice of PEP among Primary health care workers in Enugu State. Method: The study was a descriptive cross sectional study conducted in Enugu state, South East Nigeria. Data were collected from 129 health workers in 10 primary health centers using questionnaire adopted from the US guideline for the management of occupational exposure. Data was analysed using SPSS Result: About 86% (111/129) had knowledge of PEP, 92.2% (119/129) agreed that PEP reduces the risk of occupational HIV and 29% (38/129) treated themselves with PEP on exposure aggressively, while 71% (91/129) were not serious with PE treatment. On their practice of PEP, 17.8% (23/129) were frequent, 26.4% (34/129) practice is sometimes, 27.9% (36/129) were regular and 27.9% (36/129) do not practice PEP. Conclusion: The gap between the impressive knowledge or attitude on PEP by the healthcare workers and their poor practices is unacceptable. A study to determine factors that contribute to the poor practices can provide solution on how to improve on their practice and therefore, reduces the risk of getting infected when exposed to HIV.
    Journal of AIDS & Clinical Research 11/2014; 5(12). DOI:10.4172/2155-6113.1000381 · 6.83 Impact Factor
  • Official journal of the South African Academy of Family Practice/Primary Care 08/2014; 53(5):462-466. DOI:10.1080/20786204.2011.10874135