PEP a feasible HIV prevention strategy

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Providing a prescription of post-exposure prophylaxis (PEP) in advance of potential exposures to HIV may be a feasible HIV prevention strategy for individuals who occasionally put themselves at high risk of contracting the virus, according to Canadian research, reports Aidsmap.

According to the report, the study involved 79 people that were given “post-exposure prophylaxis in pocket” (PIP) over a three-year period. A fifth took PEP, with seven people taking more than one course.

All started the treatment within the recommended time-frame, were highly adherent and follow-up rates were over 90%. Dr Amenah Alghamdi and her colleagues at the University of Toronto wanted to see if PEP “in pocket” was an appropriate HIV prevention strategy for such individuals. They therefore retrospectively analysed the characteristics and PEP use of individuals prescribed PEP in this way between 2016 and 2019.

“PIP offers several advantages compared to other HIV prevention modalities for carefully selected individuals with very infrequent but high-risk exposures,” they are quoted in the report as saying. “PIP allows for the prompt initiation of ARVs following a potential HIV exposure, eliminates the need for urgent emergency department visits and subsequent referral to a specialized clinic, gives patients autonomy over their care, and allows for the democratisation of ARV access.”

Background: HIV Pre-exposure prophylaxis and post-exposure prophylaxis are two major biomedical HIV prevention modalities. The utility of these prevention tools for individuals with infrequent high-risk HIV exposures remains uncertain. HIV post-exposure prophylaxis-in-pocket (“PIP”) may be an effective HIV prevention tool in such situations. Here we present long-term follow up of a cohort of patients initiated on PIP for HIV prevention.
Methods: We retrospectively evaluated clinical characteristics of patients initiated on PIP as a primary HIV prevention tool between January 1, 2016 to May 31, 2019 at the Toronto General Hospital HIV Prevention Clinic and St Michaels Hospital HIV Clinic, both in Toronto, Canada. Patients were referred for consideration of a biomedical HIV prevention modality. Individuals with a low frequency of high-risk exposures to HIV were initiated on PIP after counselling, and were followed at regular intervals. Demographic and clinical data was collected with a standardized form.
Results: A total of 79 patients were initiated on PIP as a primary HIV prevention modality and followed for a mean duration of 14.8 months combining for a total of 97.3 patient-years. Twenty one (26.6%) patients used their PIP, and 32 courses of PIP were taken during the study period. Transitions between HIV prevention modalities included 13 (16.5%) patients who transitioned from PrEP to PIP, and 22 (27.8%) patients who transitioned from PIP to PrEP. No HIV seroconversions were detected during the course of this study.
Conclusion: PIP is helpful HIV prevention modality for individuals with a low frequency of high-risk HIV exposures.

Alghamdi, Amenah; Hempel, Amanda; Heendeniya, Amila; Clifford-Rashotte, Matthew; Tan, Darrell HS; Bogoch, Isaac I

Full Aidsmap report

AIDS abstract

The Lancet Public Health comment

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