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Post-exposure prophylaxis for preventing HIV during years 2007-2008 in an University Urban Hospital, in Paris, France
L. Fonquernie, K. Lacombe, P. Campa, O. Picard, J. Pacanowski, M.-C. Meyohas, P.-M. Girard
University Pierre et Marie Curie, Hôpital Saint-Antoine, Service des Maladies Infectieuses et Tropicales, Paris, France
Background: Although there is no still reliable evidence to support the efficiency of oral antiretroviral post-exposure prophylaxis (PEP) in preventing sexual HIV transmission, PEP is widely used in France where this treatment is free of charge.
Objectives: To describe characteristics of all persons who visited Saint-Antoine Hospital, Paris, for a potential sexual exposure in 2007-2008 and to identify differences of behaviour between groups
Methods: All patient's visits were performed using a computerized chart. A data-processing screening was used to identify their characteristics
Results: 725 cases of exposure were notified. Their main characteristics were: 573 (79%) men; median age: 31 years (18-72); prior sexual risk: 25%; HIV-negative status for case: 84%; initial diagnosis of HIV infection: 4 (0.5%); HIV status for partner: positive: 20%, negative: 4%, unknown: 76%; exposure with usual partner: 16%; type of sexual intercourse: vaginal: 40%, passive anal: 28%, active anal: 21%, receptive oral: 8%; use of condom: no: 47%, rupture: 46%, loss: 7%; ejaculation: 53%; usual use of condom: never: 4%, sometimes: 38%, always: 59%. PEP was prescribed in 84% of cases (up than 90% with tenofovir/FTC + lopinavir/r). Interruption of treatment for toxicity or non-indication was rare (2%). One HIV seroconversion was detected but a control of HIV test was available only in 27% of cases with a median follow-up of 2.5 months (0.5-5.9). Comparisons between homosexual (MSM) and heterosexual persons showed no difference for unprotected sex (47%) and age (33 vs 31 years respectively). Prior sexual risk, HIV+ and unknown partners were more frequent for MSM (30 vs 19%, 28 vs 10% and 87 vs 79% respectively; p= 0.01)
Conclusions: A high number of cases was notified, for whom PEP was frequently used and completed. Follow-up should be improved in order to avoid an underestimation of the rate of seroconversion and to identify patients who require prevention counselling.
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