Post-exposure prophylaxis following non-occupational exposure to HIV: risks, uncertainties, and ethics

Abstract

Post-exposure prophylaxis (PEP) is the standard of care for occupational exposure to HIV infection although it has not been evaluated following non-occupational exposure. Although the most effective methods for preventing HIV infection remain those that prevent exposure to HIV in the first place, this article discusses the dilemmas surrounding post-exposure therapy following non-occupational exposure.

Cost-effectiveness of Postexposure Prophylaxis After Sexual or Injection-Drug Exposure to Human Immunodeficiency Virus

“…2 Although the US Public Health Service has stated that it "cannot definitively recommend for or against antiretroviral agents in [nonoccupational] situations because of the lack of efficacy data," 3 the effectiveness of PEP in the occupational setting, together with evidence of efficacy in animal model systems, [4][5][6] has prompted physicians in the United States and abroad to consider the use of PEP for persons potentially exposed to HIV through sexual or needle-sharing activities. [7][8][9][10][11][12][13][14][15][16] The US Public Health Service has established a registry to track nonoccupational exposures to HIV and has issued preliminary recommendations regarding the use of PEP for these exposures. 3 Expert guidelines for nonoccupational PEP have been published in major medical journals.…”

The Past, Present, and Future of HIV Prevention: Integrating Behavioral, Biomedical, and Structural Intervention Strategies for the Next Generation of HIV Prevention

“…Use of ART after occupational exposure (i.e., needle sticks in health-care settings) is now routine in the developed world (Pozniak 2004). There is evidence that postexposure prophylaxis (PEP) can reduce the risk of HIV transmission (Mackie & Coker 2000). Advocates have been calling for PEP availability following nonoccupational sexual or injection drug equipment exposures (Martin et al 2004).…”

A bite in the playroom: Managing human bites in child care settings

“…Since 1998, certain clinicians have recommended wider availability and use of nPEP (52)(53)(54)(55)(56)(57)(58), and others have been more cautious about implementing it in the absence of definitive evidence of efficacy (59,60 Surveys of clinicians and facilities indicate a need for more widespread implementation of guidelines and protocols for nPEP use (61). In a survey of Massachusetts emergency department directors, 52% of facilities had received nPEP requests during the preceding year, but only 15% had written nPEP protocols (62).…”