Post-exposure prophylaxis for human immunodeficiency virus infection in the Royal Infirmary of Edinburgh - an audit

Abstract

The purpose of the audit was to assess the implementation of the protocols developed by Lothian University National Health Service Trust for post-exposure prophylaxis (PEP) against blood-borne virus infections. Patients at risk of infection after an injury were referred to the Department of Genitourinary Medicine (GUM) Edinburgh Royal Infirmary for assessment. A brief description of the incident, the time of the incident, the time of referral and the decision made was documented. The notes of these patients were reviewed 12 months later for the results of prospective HIV test after each incident. There were 76 referrals to the GUM Department in year 2001. Occupational Health (OH) and the Accident and Emergency (A&E) Departments each made 35 referrals. The latter cases were exposures in community settings. Amongst A&E referrals the time interval between the incident and assessment was significantly longer than for OH referrals (P=0.001). Female health workers reported exposure incidents sooner than their male counterparts (P=0.01). Post-exposure prophylaxis for HIV was offered to 22 (29%) of 76 referred individuals, and was accepted by 13 (59%) persons. The course of PEP drugs was discontinued by five (38%) of the 13 individuals after consented post-incident HIV testing of the source patients showed that they were HIV-seronegative. Five of eight individuals completed the course of PEP medication. Only 11 (14%) persons attended for serological testing for blood-borne virus infection three or more months after exposure. None of these 11 persons, one of whom had been given PEP medication, had become infected. Further training and emphasis on the necessity of immediate reporting of occupational incidents and consented post-incident HIV testing of the source patient is needed. The current guidelines appear to work fairly well, but further counselling of those with significant injuries to undertake HIV serological testing after appropriate time interval is required.

A review of HIV postexposure prophylaxis provision at a genitourinary medicine department

“…Just over three-quarters of the patients reviewed were initiated on PEP, compared with the low 17% demonstrated in an audit within the same department in 2001. 8 This might be related to increased clinician readiness to prescribe PEP as much as a change in the type (and therefore risk level) of exposures presenting to the department in comparison to 2001: 50 of the 85 exposures in the current audit were following a sexual exposure, compared with four of 76 exposures in the previous audit. This is likely due to better advertisement and awareness of PEPSE in some high sexual risk populations such as men who have sex with men.…”