Significant intolerability of efavirenz in HIV occupational postexposure prophylaxis

Publié le 12 janvier 2017 • Catégorie(s) : Accident d'exposition au sang • Mot(s) clef(s) : infections à VIH, personnel infirmier

Auteur        S. Wiboonchutikul
Auteur        V. Thientong
Auteur        P. Suttha
Auteur        B. Kowadisaiburana
Auteur        W. Manosuthi
Volume        92
Numéro        4
Pages        372-377
Publication        The Journal of Hospital Infection
ISSN        1532-2939
Date        Apr 2016
Résumé        BACKGROUND: Completion of human immunodeficiency virus (HIV) occupational postexposure prophylaxis (PEP) is important for successful prophylaxis. AIM: To determine factors associated with failure to complete the four-week HIV PEP. METHODS: A retrospective study was conducted among healthcare workers (HCWs) accidentally exposed to blood or body fluids of patients at the Bamrasnaradura Infectious Diseases Institute, Thailand, between March 1996 and June 2014. Logistic regression analysis was used to determine factors associated with failure to complete the four-week HIV PEP. FINDINGS: In total, 225 exposure episodes were reported. The mean age of HCWs was 33.1 (standard deviation 9.9) years, and 189 (84%) were female. Nurses (43%) were exposed most frequently. The HIV status of the source was defined in 149 (66%) episodes, and 101 (68%) of these were positive. Of 225 exposures, PEP was prescribed in 155 (69%) cases, with intentional discontinuation in 26 cases. Ninety-one of 129 (71%) HCWs completed the four-week regimen. Multi-variate analysis showed that a regimen of two nucleotide reverse transcriptase inhibitors (NRTI) + efavirenz (EFV) was the only significant factor associated with non-completion of the four-week course (odds ratio 37.8, 95% confidence interval 4.2-342.3; P < 0.01). Other factors including age, sex, staff position, status of the source and other PEP regimens were not associated with non-completion of the four-week course (P > 0.05). None of the HCWs were documented to have HIV seroconversion. CONCLUSION: A regimen of two NRTIs + EFV was significantly associated with premature discontinuation of occupational PEP. This regimen should not be used for HIV prophylaxis following occupational exposure.