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Eight years experience of prophylaxis after sexual exposure to HIV in Canada
N. Machouf, R. Thomas, S. Vezina, M.-C. Roy, B. Trottier, R. O'Brien, D. Longpré, D. Legault, D. Murphy, V.-K. Nguyen
Clinique Medicale L'Actuel, Montreal, Canada
Background: Describe non-occupational post-exposure prophylaxis (PEP) use in a large urban sexual health clinic cohort and evaluate the determinants of completing PEP follow-up.
Methods: All patients consulting at Clinique l'Actuel for PEP since 2000, were recruited in this prospective study. Patients were assessed at day 1, and then followed for 6 months. Decision to administer PEP was based on risk evaluation. We investigated the major determinants of completion of PEP follow-up (FU) by multiple logistic regression.PEP-FU was considered complete if the patient came back for HIV screening 3 or 6 months after exposition.
Results: 639 consultations (84% male, median age 33 years) for PEP were included. 81% were for a first PEP and 86% for a moderate/severe risk of exposure. No changes in characteristics of patients consulting for PEP over time were observed. Reason for consultation was 55% of homosexual risky contact, 31% of intercourse with an HIV+ partner, 9% with a sex worker, and 3% with a partner from endemic region. Median delay before consultation was 29 hours, without significant variation over time (p=0.289). Risk assessment drove PEP administration, with 98% of patients treated after a high risk, 87% treated after a moderate risk and 19% after a minor risk of exposition. Only 50% of the patients completed FU. Complete FU was more likely in patients with moderate/severe risk of exposition (OR=2.409; p< 0.001), in men (OR=1.642; p=0.032) and in older patients (OR=1.045; p< 0.001).
Conclusions: High risk sexual behaviour is common in our cohort. PEP may be an effective prevention strategy, as repeat PEP consultation was rare. Low rates of seroconversion in this high risk population suggests a preventive effect for these patients. While the high rate of loss to follow up is a limitation, those most at risk were more likely to complete follow-up, giving added opportunities for prevention counselling.
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