Program Supplement [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

Late Breaker Abstracts

Oral Sessions
iBOR0oAI
Management of post-exposure prophylaxis after occupational
exposure to HIV in healthcare workers in Europe
Cicalini, Stefania1, Antunes, Francisco2, Balslev,
Ulla3, Bernasconi, Enos4, Boaventura, Jos Luis2, Campins,
Magdas, Evans, Barry6, Francioli, Patrick4, Genasi,
Fiona6, Larsen, Christine7, Lot, Florence7, Lunding,
Suzanne3, Marcus, Ulrich8, Pereira, Alvaro2, Schonwald,
SlavkO9, Thomas, Tania6, De Carli, Gabriella, Ippolito,
Giuseppe', Puro, Vincenzo'
(ltaly; 2Portugal; 3Denmark; 4Switzerland; sSpain;
6United Kingdom; 7France; 8Germany; 9Croatia)
Background: Occupational post-exposure prophylaxis (OPEP)
against H IV represents the standard of care in exposed
healthcare workers (HCW), but no general consensus exists on
some issues.
Methods: On September 2001, the European Commission
funded a project co-ordinated by Italy (I), to evaluate and
standardize the management of OPEP in Europe. Croatia (C),
Denmark (DK), United Kingdom (UK), France (F), Germany (D),
Portugal (P), Spain (E), Switzerland (CH), participate in the
project. Existing guidelines (GL) were collected; policies,
procedures and data regarding OPEP were investigated
through a questionnaire and discussed with representatives of
participating Countries.
Results: All Countries have National or hospital (P, C) GL that
recommend starting 4-week PEP as soon as possible, with 3
drugs regardless of risk assessment in UK, CH, F, D, DK, or only
in high risk exposure in C, E, I, P. The interval after which PEP is
discouraged ranges from 24 h (I, DK) to 72 h (CH, D, E, P),
allowing 14d for high risk exposures (UK, P). HIV testing
schedule differs in timing, with HIV-Ag/RNA performed only in
F. PEP is available in all (F, UK) or larger (P, E, CH, C) hospitals,
or in hospitals with an infectious diseases department (D, DK,
I). PEP collected cases approximate looo/year [data from the
National Registry (CH, DK, F, I, UK); from a network of hospitals
(E), or a University hospital (C); not available (P, D)].
Acceptance rates varied from 28% (E) to 73% (UK); the
proportion of HCW who completed PEP ranged between 25%
(UK) to 84% (F). A significant number of PEP is started after
exposure to a source who later tested HIV negative, lasting a
mean of 1-4 days. Rapid HIV testing is rarely used.
Conclusions: OPEP is widely prescribed in EU Countries,
though differing in several aspects. Uniform GL should be
developed to implement a rapid risk assessment, optimize
availability and management, and minimize unnecessary
treatments and related toxicity and costs.
Corresponding author: Cicalini, Stefania, Dipartimento di
Epidemiologia, INMI Spallanzani, Via Portuense 292, Rome,
Italy, Tel: [phone], Fax: [phone],
Email: [email protected]

SLBOROIB I
Proposed European Recommendations for Post-Exposure
Prophylaxis against HIV infection in Health Care Workers
Puro, Vincenzo', Cicalini, Stefanial, Schonwald,
Slavko2, Balslev, U//a3, Lot, Florence4, Marcus,
Ulrichs, Boaventura, lose Luis6, Campins, Magda7, Bernasconi,
Enos8, Thomas, Tania9, De Carli, Gabriella, Ippolito on behalf
of the EuROPEP Study Group, Giuseppe'
(/taly; 2Croatia; 3Denmark; 4France; 5Germany; 6Portugal;
7Spain; 8Switzerland; 9United Kingdom)
Background: Management of occupational H IV post-exposure
prophylaxis (PEP) varies among European countries, and
several issues remain controversial.
Methods: In September 2001, the European Commission
funded a project to standardise the management of
occupational HIV PEP in,irope. During a 2-day consensus
meeting, expert representatives from Italy, Croatia, Denmark,
United Kingdom, France, Germany, Portugal, Spain,
Switzerland reviewed and discussed available National
recommendations and policies, data from local surveillance
programs and current literature, thus issuing a consensus
document.
Results: The consensus document recommends that all efforts
should be made to prevent occupational exposures. PEP
prescription should be based on the type of exposure, body
material involved and source patient's evaluation. After the
source patient's consent to H IV testing, "immediate" results
should be obtained in order to prevent unnecessary PEP, also
by using rapid HIV-antiFody tests. PEP should be initiated as
soon as possible and is discouraged after 72 hours from
exposure. A 4-week course of any combination of
antiretrovirals approved for the treatment of HIV patients could
be used in a PEP regimen. Triple therapy (i.e. 2 NRTI + 1 PI or 1
NNRTI) is recommended as a first line PEP regimen. The source
patient's history about previous and current antiretroviral
treatments may be important in the choice of PEP regimen. HIV
testing should be performed shortly after exposure and
thereafter at 6 weeks, 3 and 6 months. The routine use of
direct virus assays (HIVp24Ag, HIV-RNA) in an exposed
healthcare worker is not recommended. Drug adherence and
tolerability should be monitored.
Conclusions: A standardized management of PEP in EU
countries could effectively improve occupational safety in the
healthcare setting, in increasing our understanding of efficacy
and toxicity of antiretroviral drugs and optimising the use of
available resources to reduce the risk of HIV infection.
Corresponding author: Puro, Vincenzo, Dipartimento di
Epidemiologia, INMI Spallanzani, Via Portuense 292, Rome,
Italy, Tel: [phone], Fax: [phone],
Email: [email protected]

XIV International AIDS Conference BARCELONA - JULY 7-12

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