Several studies suggest that HIV acquisition can be reduced significantly with antiretroviral
post-exposure prophylaxis (PEP). Recently the recommended occupational HIV PEP regimen
was changed by CDC and New York State Department of Health to tenofovir + emtricitabine
and raltegravir (TNF/FTC/RAL), principally to lessen side effects and simplify regimen
choices. Studies of TNF/FTC/RAL in non-occupational PEP have shown the regimen to
be well tolerated and better completed, but there are no studies to date in an occupational
setting. The goal of this study is to compare the newly recommended occupational HIV
PEP regimen to prior regimens in terms of tolerability, adherence, and completion
rates in exposed healthcare workers.
In this retrospective case control study, we reviewed the charts of 160 employees
at risk for HIV infection due to occupational exposure at Montefiore Medical Center
in the Bronx NY from 2007-2013. We assessed risk of the exposure, initial PEP regimen,
changes in regimen, rates of completion, costs, and side effects due to medications.
Of the 160 employees, 153 had initial and follow-up information. Of these, 93 initially
started on zidovudine + lamivudine and lopinavir/ritonavir (ZDV/3TC/LPV) were compared
to 48 initially started on TNF/FTC/RAL. 40 of 93 (43%) of those in the ZDV/3TC/LPV
group completed 4 weeks of therapy vs 31 of 48 (65%) of those in the TNF/FTC/RAL group
(p = 0.015). 68 of 93 (73%) of employees receiving ZDV/3TC/LPV reported side effects,
compared to 27 of 48 (56%) of those receiving TNF/FTC/RAL (p = 0.043). Further analyses
will be presented at the meeting.
Employees receiving tenofovir + emtricitabine and raltegravir for occupational HIV
post-exposure prophylaxis were more likely to complete the recommended 4 week course
of therapy, and reported fewer side effects than those who received the prior recommended
regimen of zidovudine + lamivudine and lopinavir/ritonavir. Tenofovir + emtricitabine
and raltegravir appears to be superior to older regimens in key parameters critical
to the success of occupational PEP programs.
All authors: No reported disclosures.