The morning after post exposure prophylaxis
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The Morning After: Post-Exposure Prophylaxis. Data Supporting Probable Efficacy of Non-Occupational PEP. Occupational exposure data Mother-to-child data Animal exposure data Timing Duration Oral Exposure. Occupational Case Control Mother-to-Child Transmission Randomized controlled trial.

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The Morning After: Post-Exposure Prophylaxis

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The morning after post exposure prophylaxis

The Morning After:Post-Exposure Prophylaxis


Data supporting probable efficacy of non occupational pep

Data Supporting Probable Efficacy of Non-Occupational PEP

  • Occupational exposure data

  • Mother-to-child data

  • Animal exposure data

    • Timing

    • Duration

    • Oral Exposure


Data supporting probable efficacy of non occupational pep1

Occupational

Case Control

Mother-to-Child Transmission

Randomized controlled trial

81% reduction in healthcare workers

ZDV versus no PEP

2/3 reduction in mother-to-child

Pre- and intra-partum ZDV versus placebo

Data Supporting Probable Efficacy of Non-Occupational PEP

Cardo DM, et al. N Engl J Med 1997; 337:1485-90

MMWR Morb Mortal Wkly Rep 1996; 45:468-80


Data supporting probable efficacy of non occupational pep2

Mother-to-Child Transmission

Retrospective chart review

81% reduction in healthcare workers

ZDV versus no PEP

2/3 reduction in mother-to child

Pre and intra-partum ZDV versus placebo

Data Supporting Probable Efficacy of Non-Occupational PEP

Cardo DM, et al. N Engl J Med 1997; 337:1485-90

MMWR Morb Mortal Wkly Rep 1996; 45:468-80


Relationship between time of initiation of therapy and subsequent infection rate

Relationship Between Time of Initiation of Therapy and Subsequent Infection Rate

Wade NA, et al., N Engl J Med 1998; 339:1409-14


Relationship between timing of animal exposure efficacy of pep

Use of PMEA with Intravenous SIV

Use of tenofovir with IntravaginalHIV-2

24 hours is better than 48 or 72 hrs.

Not effective after 72 hours

12 and 36 hours are effective

72 hours results in incomplete suppression (1 seroconversion)

Relationship Between Timing of Animal Exposure Efficacy of PEP

Tsai, CC, et al. J Virol 1998; 72:4265-73

Otten RA, et al. J Virol 2000; 74:9771-5


Relationship between duration and route of animal exposure efficacy of pep

Use of PMEA with Intravenous SIV

Use of tenofovir with newborn macaques given oral SIV

28 days was 100% protective

10 and 3 day exposure ineffective even 24 hours after exposure

Combination pre- and post- exposure was effective

Pre-exposure not effective

Relationship Between Duration and Route of Animal Exposure Efficacy of PEP

Tsai, CC, et al. J Virol 1998; 72:4265-73

Van Rompay, et al. AIDS Res Hum Retroviruses 1998; 14:761-73 Van Rompay ,et al. Aids 1998;12:F79-83 Van Rompay, et al., J Virol 2000; 74:1767-74


When to consider post exposure prophylaxis

Timing

Exposure types

Within 72 hours

Anal and vaginal intercourse

Insertive and receptive

Receptive oral intercourse with ejaculation

Shared IDU

Body fluid on mucous membrane/ broken skin

When to Consider Post Exposure Prophylaxis

Rolland, MM 2002


When to consider post exposure prophylaxis1

Source

Known HIV infected

Men who have sex with men (MSM)

Injection drug use

Anonymous

Unknown risk factors

When to Consider Post Exposure Prophylaxis

Rolland, MM 2002


Comprehensive post exposure prophylaxis program

Medications

Recommended: 2 nucleoside analogues

Unknown importance of ZDV

Consider protease inhibitor

NVP is contraindicated

Comprehensive Post Exposure Prophylaxis Program

Rolland, MM 2002


Comprehensive post exposure prophylaxis program1

Duration

Follow-up HIV testing

28 days

Baseline, 2-3 months, 6 months

Consider adding 4-6 week and 12 months time points

Comprehensive Post Exposure Prophylaxis Program

Rolland, MM 2002


Comprehensive post exposure prophylaxis program2

Other testing and interventions

STD treatment and screening

Hepatitis B and C screening

Hepatitis A and B immunization

Routine safety labs orper specific medications, history, and symptoms

Comprehensive Post Exposure Prophylaxis Program

Rolland, MM 2002


Comprehensive post exposure prophylaxis program3

Comprehensive Post Exposure Prophylaxis Program

  • Counseling and referrals

  • Risk reduction counseling

  • Referrals for:

    • Substance abuse

    • Mental health

Rolland, MM 2002


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