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Only 1% HIV Diagnosis Rate More Than 6 Months After PEP in 975 People
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17th European AIDS Conference, November 6-9, 2019, Basel
Mark Mascolini
Among 975 people using postexposure prophylaxis (PEP) at the University Hospital of Zurich in 2007-2013, only 10 (1.03%) got diagnosed with HIV more than 6 months after using PEP [1]. HIV seroconverters were all men who have sex with men (MSM), had a strong PEP indication, and tended to use PEP repeatedly.
Before University Hospital of Zurich researchers and colleagues at other center undertook this study, no data had been presented on long-term outcomes in people seeking PEP after possible sexual exposure to HIV. The Zurich team conducted a retrospective data-linkage study to estimate the number of late HIV diagnoses (at least 6 months after PEP use) in people who sought PEP from 2007 through 2013.
The researchers reviewed 1051 PEP consultations and identified 975 PEP users who had condom-free anal, vaginal, or oral sex within the past 72 hours with an HIV-positive partner who had a detectable viral load or a partner with an unknown HIV status but at high risk for HIV infection. To explore long-term HIV outcomes in PEP users, the investigators linked the hospital PEP database to the University Hospital of Zurich electronic patient record system, the Zurich Primary HIV Infection cohort, and the Swiss HIV Cohort Study.
This analysis yielded 17 potential internal links and 34 potential external links. After eliminating duplicates, HIV diagnoses at the PEP visit, probable PEP failures, and cases with other problems, the researchers examined 21 records that yielded 10 long-term HIV infections among the original 975 people, for an HIV diagnosis rate of 1.03%.
Nine of the 10 people with a later HIV diagnosis had a verified PEP indication and 1 did not. Four people used PEP repeatedly and so may have avoided HIV with PrEP. A median 3.8 years (interquartile range 2.3 to 6.4) passed between the PEP consultation and the positive HIV test. Compared with persistently HIV-negative PEP users, people diagnosed with HIV after PEP use were more likely to use PEP repeatedly (40% versus 10%) and more likely to have a strong PEP indication (90% versus 54%). All 10 PEP users with a long-term HIV diagnosis were MSM.
The researchers concluded that, "although HIV diagnoses were scarce, PEP seekers who seroconverted seem to share a specific risk profile." Identifying these high-risk PEP users and encouraging PrEP use could probably prevent some HIV infections.
Reference
1. Hovaguimian F, Hauser C, Battegay M, et al. HIV infection in individuals seeking post-exposure prophylaxis (PEP): a retrospective data linkage study. 17th European AIDS Conference, November 6-9, 2019, Basel. Abstract BPD3/1.
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