Choice of Antiretroviral Drugs for Postexposure Prophylaxis for Adults and Adolescents: A Systematic Review

Ford, Nathan; Shubber, Zara; Calmy, Alexandra; Irvine, Cadi; Rapparini, Cristiane; Ajose, Olawale; Beanland, Rachel; Vitória, Marco; Doherty, Meg; Mayer, Kenneth H.

doi:10.1093/cid/civ092

Cited by 39 publications

(26 citation statements)

References 36 publications

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“…In seven PEP studies published since 2001, 51% of the total 1009 participants reported at least one AE and about 20% failed to complete the 28-day course [5, 9–14]. The most common side effects we found were similar to those reported in studies with raltegravir, with similar frequency of nausea, vomiting, diarrhea, abdominal discomfort, headache, and fatigue but less myalgias or arthralgias [6, 7], which were reported only twice in our study.…”

Section: Discussionsupporting

confidence: 70%

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Evaluation of tolerability with the co-formulation elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate for post-HIV exposure prophylaxis

et al. 2016

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BackgroundThe preferred regimen for HIV post-exposure prophylaxis (PEP) is based mainly on safety and tolerability because it is given to immunocompetent people without HIV infection for a limited time (28 days). The frequency of adverse events (AEs) may be > 60%. Although AEs are generally not severe, they can lead to lack of adherence and failure to complete the regimen. We evaluated the co-formulation elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate (Stribild®) prescribed as one pill taken once daily for HIV PEP in terms of tolerability and adherence.MethodsThis was a prospective cohort study conducted in one hospital in Paris (April to December 2015. Each participant receiving the PEP treatment (FTC-150 mg/TDF-245 mg/elvitegravir-200 mg/cobicistat 150 mg once daily) at the pharmacy of the hospital were recruited consecutively. A clinical visit was planned at 8 weeks after sexual exposure. Reminders were sent to participants who missed the appointment. A standardized questionnaire was administered to evaluate completeness and tolerability at week 8.ResultsOverall, 284 participants (86% men; 80% MSM; median age 30 years) were prescribed Stribild®; 50 stopped after reassessment of risk. Among 234 participants who effectively received PEP, 215 (92%) completed 28 days of PEP with only three who switched from Stribild® to another PEP because of side effects. More than 60% of participants reported at least one AE, which were mild to moderate. Fatigue, central neurological and abdominal side effects were the most frequently reported.ConclusionsStribild® seems to be a good option for HIV PEP due to the easiness of use, the side effects profile and the high completion rate.

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Section: Discussionsupporting

confidence: 70%

“…In well-resourced settings, a recent policy shift for HIV PEP has been toward combining TDF and FTC with raltegravir as the third drug even if data are still limited in this indication [6]. The short-term tolerability of a regimen including an integrase inhibitor as a third agent has been reported in some studies of raltegravir [4, 7, 8].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of tolerability with the co-formulation elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate for post-HIV exposure prophylaxis

et al. 2016

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“…Furthermore, many of the PEP regimens used in these studies included poorly tolerated antiretroviral drugs. A recent systematic review reported that tenofovir disoproxil fumarate (TDF) based PEP was better tolerated with higher completion rates than zidovudine based PEP, which used to be the standard of care [14]. The WHO now recommends the use of TDF as part of the backbone for PEP regimens [15].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with loss to follow-up after occupational HIV exposure in Cape Town, South Africa: a retrospective cohort study

et al. 2017

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BackgroundThere is limited data on factors associated with loss to follow-up (LTFU) of health care workers (HCWs) following occupational exposure to HIV, and most studies were conducted in an era when poorly tolerated antiretrovirals like zidovudine were used.MethodsA retrospective cohort study was conducted of HCWs attending a referral hospital’s Occupational Health Clinic in Cape Town, South Africa for post-exposure prophylaxis (PEP) during a period when tenofovir was available. Our primary outcome was LTFU at the 3-month visit. We selected seven variables a priori for our logistic regression model and ensured there were at least 10 outcome events per variable to minimize bias.ResultsTwo hundred and ninety-three folders were evaluated for descriptive analysis. LTFU worsened with successive visits: 36% at 6 weeks, 60% at 3 months, and 72% at 6 months. In multivariate analysis at the 3-month visit LTFU was associated with age (adjusted odds ratio (aOR), 0.6 per 10-year increase [95% CI, 0.5–0.9]), HCW category of doctor (aOR 2.7 [95% CI, 1.3–5.5]), and time from exposure to receiving PEP of more than 24 h (aOR 5.9 [95% CI, 1.3–26.9]).ConclusionWe identified factors associated with LTFU of HCWs after occupational HIV exposure, which could be used to target interventions to improve follow-up.

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“…Antiretroviral therapy was most often poorly tolerated; protocols should be optimised to maximise adherence 15. Studies also demonstrated that handing out the full 28 days of treatment at once rather than a 3-day starter pack improves compliance and facilitates the whole process for patients; this should be discussed according to the organisation in each reference centre 16.…”

Section: Discussionmentioning

confidence: 99%

Experiences of HIV postexposure prophylaxis (PEP) among highly exposed men who have sex with men (MSM)

et al. 2017

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Twenty-three patients were eligible for the qualitative study. Thirteen interviews were carried out. All patients were 20-60-year-old MSM. The median time between PEP and HIV diagnosis was 3.3 years (interquartile range (IQR)=0.9-4.9). Many participants reported negative PEP experiences: awkward access to the PEP clinic, uneasiness and shame in the hospital setting, unpleasant interaction and moral disapprobation from the medical staff, treatment intolerance and prevention messages that were 'inconsistent with real life' CONCLUSION: Our data highlight PEP management failures among its target population that may have compromised any subsequent attempts to seek out PEP. Practitioners should be more aware of MSM sexual contexts and practices. PEP consultations should provide the opportunity to discuss prevention strategies with highly exposed HIV-negative subjects, which may include pre-exposure prophylaxis.

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Choice of Antiretroviral Drugs for Postexposure Prophylaxis for Adults and Adolescents: A Systematic Review

Cited by 39 publications

References 36 publications

Evaluation of tolerability with the co-formulation elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate for post-HIV exposure prophylaxis

Evaluation of tolerability with the co-formulation elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate for post-HIV exposure prophylaxis

Factors associated with loss to follow-up after occupational HIV exposure in Cape Town, South Africa: a retrospective cohort study

Experiences of HIV postexposure prophylaxis (PEP) among highly exposed men who have sex with men (MSM)

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