Abstract
ObjectivesThe care of exposed individuals to HIV remains a challenge regarding follow-up completion and HIV-testing of the partner. Identifying patients with risk of not fulfilling HIV-testing follow-up completion (FC), among patients demanding non-occupational post-exposure prophylaxis (nPEP), may improve clinical practice.MethodsA retrospective chart review was conducted in a single French HIV-infection care center. FC predictors were assessed in a multivariate logistic regression model (Likelihood ratios test).ResultsBetween 2009 and 2013, 646 sexual exposures to HIV were evaluated for nPEP, of which 507 effectively received nPEP (78%). FC rate was 30% (194/646). In the multivariate analysis, FC rates rose with age of exposed individuals (OR, 1.04 [0.25–4.28]; p<0.001) and decreased with the year of sexual exposure (OR, 0.74 [0.65–0.85]; p<0.001). FC was associated with sexual encounter with a sex worker (OR, 4.07 [0.98–16.82]; p<0.001) and nPEP use (OR, 2.69 [2.37–3.06]; p<0.001). nPEP early discontinuation was associated with decreased FC rates (OR, 0.18 [0.08–0.39]; p<0.001). No documented nPEP failure was identified. However, five Men who have Sex with Men (MSM) nPEP recipients for unprotected anal receptive intercourse subsequently seroconverted to HIV more than 6 months after nPEP. Seroconversion to HIV was associated with the lack of FC (p = 0.04) and multiple presentations for nPEP over the study period (p = 0.002).ConclusionsWe identified significant predictors of not fulfilling sequential HIV-testing. They appear to be linked with a self-perceived HIV risk, especially in young adults recently exposed. Enhanced counseling in targeted individuals with high risk behaviors and using smartphone and internet-based strategies may be interesting retention in care options.
Highlights
Biomedical prevention care for sexual exposure to HIV is recommended in both the US and Europe [1,2]
follow-up completion (FC) was associated with sexual encounter with a sex worker (OR, 4.07 [0.98–16.82]; p
Five Men who have Sex with Men (MSM) nPEP recipients for unprotected anal receptive intercourse subsequently seroconverted to HIV more than 6 months after nPEP
Summary
Biomedical prevention care for sexual exposure to HIV is recommended in both the US and Europe [1,2]. NPEP is used since the late 1990s [5], comprehensive data that address current sexual exposures to HIV care practices are limited [6,7,8,9], suggesting that it is often underused by men who have sex with men (MSM) [6]. National Recommended standard follow-up includes HIV antibodies testing at baseline and six weeks; or at baseline, eight and 16 weeks after sexual exposure for untreated and treated patients, respectively [16]. Targeting patients with risk of not fulfilling HIV-testing follow-up completion (FC) may improve clinical practice
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