Post-Exposure Prophylaxis Following Consented Sexual Exposure

Impact of National Recommendations on User Profile, Drug Regimens and Estimates of Averted HIV Infections

IO Pereira; ARP Pascom; G Mosimann; F Barros Perini; RA Coelho; F Rick; A Benzaken; VI Avelino-Silva

Disclosures

HIV Medicine. 2020;21(4):240-245. 

In This Article

Abstract and Introduction

Abstract

Objectives: The aim of the study was to describe the characteristics, impact and outreach of post-exposure prophylaxis (PEP) for sexual exposure in Brazil.

Methods: We used secondary data from the Brazilian Ministry of Health to describe the impact of national guidelines on the frequency of prescription, user profile and antiretroviral regimens. We also estimated the number of potentially averted HIV infections attributable to PEP for consented sexual exposure between 2009 and 2017.

Results: A total of 260 457 PEP regimens were prescribed to individuals ≥ 14 years old; 104 613 (40.2%) were prescribed for consented sexual exposure, with an increasing frequency since 2011. Drugs used in PEP regimens underwent significant modifications during the period, reflecting national recommendations. We estimated that there were up to 3138 potentially averted HIV infections attributable to PEP for consented sexual exposure between 2009 and 2017.

Conclusions: In the context of a combined HIV prevention strategy, PEP is still an essential tool for individuals for whom other methods are contraindicated or fail to be applied.

Introduction

Post-exposure prophylaxis (PEP) is the oldest of the antiretroviral (ARV)-based HIV prevention strategies, which currently include treatment as prevention (TASP) and pre-exposure prophylaxis (PrEP).[1] Evidence for PEP use following sexual exposure (PEPSE) or occupational exposure is based on experimental animal studies[2–4] and limited human observational studies, including a case–control study of PEP among health care workers following occupational exposure[5] and one cohort study among high-risk men who have sex with men.[6] Despite the lack of evidence from human randomized trials, recommendations for PEP have been widely implemented.[1,7–9]

PEP has been implemented in the free-of-charge public health system [Sistema Unico de Saude (SUS)] in Brazil since 1999, a few years after national guidelines for universal and free access to antiretroviral therapy (ART) were issued, in 1996. Over the past 19 years, health care providers and administrators have witnessed significant changes in the prescription frequency, target population, and drug regimens used for PEP. In the early years, most PEP regimens were prescribed for occupational exposure events, and recommendations for nonoccupational exposure mainly focused on sexual assault cases. Since 2012, PEP recommendations for consensual sexual exposure were more distinctly made in national HIV treatment and prevention guidelines,[10] and in 2015 the first PEP-specific national guideline was launched. Moreover, prophylactic ART regimens have been changing over the years, reflecting guideline recommendations and the increasing availability of drugs with improved tolerability. However, it is difficult to determine if PEPSE fulfills the aim of preventing HIV infection among those actually in need in Brazil.

To address the characteristics, impact and outreach of PEPSE in Brazil, we analysed PEP prescriptions from 2009 to 2017, compared the main characteristics of the population receiving PEP to the characteristics of those with newly diagnosed HIV infection, and estimated the number of potentially averted sexual HIV transmissions in the period using national-level data from the Ministry of Health (MoH) of Brazil.

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