Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 33183-33187 629

576*/33183 Potential public health impact of offering
post-exposure prophylaxis (PEP) for episodic
high-risk sexual behavior by men who have sex
with men (MSM)
Grant Colfax', E. Vittinghoff1, K. MacQueen2, J. Douglas3, D. McKirnan4,
F. Judson', S. Buchbinder3. Department of Public Health, Suite 500, 25 Van
Ness Avenue, San Francisco, CA, 2Centers for Disease Control & Prevention,
Atlanta, GA; 3Department of Public Health, Denver, CO; 4University of Illinois,
Chicago, IL, USA
Background: Previous analysis suggest that the probability of HIV infection from
unprotected receptive anal intercourse (URAI) with an HIV positive (+) or unknown
(U) serostatus partner is approximately one log higher than from other sexual
activities with + or U. We modeled the maximal impact on HIV seroincidence (HIV
SI) of offering PEP for episodic URAI with a + or U partner.
Methods: Data were modeled in the CDC HIV SI Study, a 3-city, 18-month
prospective cohort of 2,189 high-risk MSM enrolled in 1993-4. Risk assessment
and HIV testing were performed semiannually; HIV SI was 2.1/100 person-years.
The number of seroconversions averted was approximated by the number of
seroconverters (SC) eligible for PEP x access rate x PEP efficacy. Maximal
impact of episodic PEP on HIV SI was modeled assuming: 1) PEP efficacy 80%;
2) PEP was limited to men with -2 URAI episodes with + or U per 6-month period,
and 20 or 80% of episodes were treated; 3) for SC in PEP eligible groups (n = 5
SC of 96 eligible URAI contacts w/ +, n = 17 SC of 894 eligible URAI contacts w/
+ or U), seroconversion was attributed to URAI rather than other sexual practices;
and 4) drug injectors were excluded.
Results:
PEP for 1-2 episodes PEP efficacy Access rate reduction SI PEP courses/case averted
URAI with + 80% 20% 1.5% 24
80% 80% 6.0% 24
URAI with + or U 80% 20% 5.2% 66
80% 80% 21% 66
Conclusions: Assuming high rates of efficacy and PEP usage, offering PEP to
MSM with episodic URAI may significantly reduce HIV SI with relatively few treatment courses, but only if treatment criteria include URAI with U. Since true PEP
efficacy and access rates remain to be determined, and because PEP access
may lead to changes in risk behavior or reporting of such behaviors, the actual
impact of episodic PEP for URAI is unknown. Studies measuring PEP utilization
and its impact on HIV seroincidence are needed.
S33184 | Post-exposure prophylaxis for sexual risks: Implications
for behavioral prevention interventions
Seth Kalichman. Center for AIDS Intervention Research, Milwuakee, WI; 2892
Windfield Circle, Tucker, GA, USA
Objectives: To assess the psychological and behavioral characteristics of men
who intend to use anti-retroviral post-exposure prophylaxis (PEP) to prevent HIV
infection.
Design: Community-based anonymous survey.
Methods: Men who have sex with men (MSM) who had not tested HIV seropositive and were not in long-term exclusive sexual relationships (N = 327) completed
anonymous surveys consisting of demographic characteristics, gay community
acculturation, experience with and attitudes toward PEP, substance use and sexual behavior in the past 6 months. Surveys were collected at a large annual Gay
Pride festival in 1997 in Atlanta, Georgia, USA.
Results: There were 8 (3%) men who had used PEP and 85 (26%) who planned
to use PEP to try to prevent themselves from becoming HIV infected. Compared
to the 242 (74%) men who did not indicate plans to use PEP, those planning to
use PEP were younger, less well educated, more likely to use marijuana, nitrite
inhalants, and cocaine in the past 6 months and were more likely to have a
history of injection drug use. Men intending to use PEP were also more likely
to have practiced unprotected anal and oral intercourse as the receptive partner
and were more likely to have multiple anal intercourse partners with whom they
were receptive.
Conclusions: MSM are generally supportive of the use of PEP and a significant number of men are planning to use PEP, particularly younger men who
use multiple substances who are at greatest risk for HIV infection. Concurrent
behavioral interventions must therefore be considered critical in the advancement
of PEP.
33185 National clinicians' post-exposure prophylaxis hotline
(PEPLine)
Julie L. Gerberding 2, Jennifer L. Perlman2, C. Gruta2, R. Fahrner2,
P. Liljestrand2, R. Goldschmidt2. 1EPI - Center at SFGH Bldg 100 Room 301
1001 Potrero Ave. San Francisco, CA 94110; 2University of California at San

Francisco San Francisco, CA, United States
Issues: In 1996, combination antiretroviral chemotherapy to prevent HIV infection
after exposure (post-exposure prophylaxis - PEP) became a standard of care for
managing occupational HIV exposures. Current USPHS PEP guidelines provide
basic treatment advice, but must be adapted to complex cases (e.g., source pt
taking several antiviral drugs/risk for AZT/3TC resistance; pregnant heath care
workers (HCW); co-exposure to HBV/HCV; unknown source pt). Many clinicians

require rapid access to expert consultation to optimally manage complicated PEP
cases.
Methods: The PEPLine (supported by HRSA/CDC) was implemented 11/21/97
at UC San Francisco/San Francisco General Hospital (SFGH) by merging 2 existing programs - the National HIV Telephone Consultation Service (Warmline) and
the SFGH Needlestick Hotline. PEPLine provides immediate telephone consultation to clinicians treating HIV-exposed HCW 24 hr/day 7 days/wk. Expert MDs.
NPs, and PharmDs provide advice about exposure risk assessment, indications
for PEP, PEP regimens/complications, and exposure follow-up. Non-emergency
calls are returned the next business day.
Results: In the first 2 months, PEPLine clinicians received 306 exposurerelated calls; the proportion of "hot" calls (those requiring immediate advice about
a specific exposure) has increased to 71%. 65% of calls were received during
non-business hours. Primary reasons for calling included exposure risk assessment/triage (42%); need for PEP (34%); PEP regimen/complications (16%); misc.
(6%).
Lessons Learned: The advent of new PEP protocols and new antiviral drug
regimens for HIV has complicated HIV exposure management. Clinicians who
treat exposed health care workers (even those experienced with HIV treatments
and occupational exposure management) utilize this state-of-the-art knowledge
resource. PEPLine will help optimize post-exposure treatment for occupational
exposures and hopefully help prevent HCW infections.
S33186 Feasibility of post-exposure prevention research among
women at HIV risk through heterosexual exposure
Richard Novak1, J. David McKirnan1, Carrol Smith', David Metzer2,
Pamela Brown Peter3, Kenneth Mayer4, Michael Marmor5. 1808 S. Wood,
Chicago; 2University & Woodland Ave. Bid. 7, CODE 116 Philadelphia, PA;:310
E. 67th New York Blood Center New York, NY; 4 Memorial Hospital Division of
Infec. Dis. 111 Brewster St. Pawtucket, RI; 5New York University Medical Center
Div of Epid. & Biostistics 341 E. 25th St. 220 RM New York, NY, USA
Objectives: To assess the knowledge and attitudes of HIV at-risk women towards
post exposure HIV prophylaxis (PEP) as a measure of the feasibility of conducting
PEP research in women.
Design: Cross-sectional analysis of a prospective observational study
Methods: A subset of HIV-seronegative women enrolled in the Vaccine Preparedness Study of the HIV Network for Prevention Trials (HIVNET) were surveyed from Oct-Dec, 1997 during a scheduled visit. The instrument assessed
knowledge of PEP medications, willingness and barriers regarding participation
in a PEP protocol, potential effects on risk behavior during PEP, and willingness
to call a clinic within 72 hours of three types for increasingly risky exposures.
Results: Data were obtained from 53 women in four US cities. 30% had previously heard of combination therapy for HIV, whereas 23% had heard of PEP.
68% reported some willingness to participate in a PEP protocol. 64-83% reported
willingness to call a clinic within 72 hours of a high risk exposure: willingness
increased according to the risk severity of the exposure, indicating some understanding of the concept of PEP. 68% reported they would feel more protected
from HIV while in a PEP protocol, and the single most common study motive
reported was HIV protection (44%). Of potential barriers, 30% reported fears
regarding pregnancy and 49% were concerned about having PEP drugs in the
household, In open-ended questions, 37% saw no disadvantages to PEP study
participation; 35% were concerned about the effects of the PEP regimen itself. Of
women willing to take PEP, 55% expected that they would take -3 courses over
a 6 month period, but 45% anticipate using it only 1-2 x in 6 months.
Conclusions: Participants' initial attitudes were positive toward participating
in PEP research and/or using PEP. Some data suggest that risk behavior may
increase if PEP were available. The primary barriers appears to be concern about
having medications in the household, and side effects of the medication regimen
itself. Overall, responses indicate feasibility of conducting PEP research in HIV
at-risk women.
S33187 Implementation of a surveillance and prevention program
for blood and body fluid occupational exposure in Rio de
Janeiro City
Cristiane S. Rapparini, S.C. Cavalcante, B. Durovni, W. Toschi, A.F. Fonseca.
Rio de Janeiro City Health Secretariat, Rua Adolfo Vasconcellos 245/1307,
Barra Datijuca 22793380 Rio de Janeiro, Brazil
Objective: To establish a surveillance system and a network to provide counseling
and HIV post-exposure prophylaxis (PEP) to health care workers (HCW).
Methods: In January 1997 the AIDS program of the Rio de Janeiro city Health
Secretariat started a surveillance and prevention program through the following
steps:
(1) Elaboration of guidelines for management of occupational exposure.
(2) Development and implementation of report forms for the occupational
exposure and the HCW follow-up.
(3) Selection of health care units to be the regional reference for counseling,

PEP prescription, drugs delivery and HCW follow up.
(4) Training the professionals from the reference units in biosafety and PEP
procedures.
Results: Two hundred forty four HCW were trained through 10 workshops.
Twenty eight reference centers were organized to cover all 30 administrative
regions of the city. 556 reports were received until December 1997 from 80 different health units. In 80.4% of the reported exposures counseling and medication