To prescribe, or not to prescribe: decision making in HIV‐1 post‐exposure prophylaxis

• Published in: HIV medicine 2018-10, Vol.19 (9), p.645-653
• Main Authors: Scholten, M, Suárez, I, Platten, M, Kümmerle, T, Jung, N, Wyen, C, Ernst, A, Horn, C, Burst, V, Suárez, V, Rybniker, J, Fätkenheuer, G, Lehmann, C
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Anti-HIV Agents - therapeutic use; Clinical Decision-Making; Decision making; Drug Prescriptions - statistics & numerical data; Emergency medical services; Emotions; Exposure; Female; Guidelines; Health risks; HIV; HIV Infections - prevention & control; HIV Infections - psychology; HIV post‐exposure prophylaxis; HIV post‐exposure prophylaxis guidelines; HIV post‐exposure prophylaxis prescription; HIV prevention; HIV-1 - drug effects; Human immunodeficiency virus; Humans; Infectious diseases; Male; Medical personnel; Occupational Exposure; Occupational health; Patients; Physicians; Post-Exposure Prophylaxis - methods; Practice Guidelines as Topic; Prescriptions; Prophylaxis; Retrospective Studies; Risk analysis; Risk assessment; Sex Work - psychology; Sex Work - statistics & numerical data; Sexual and Gender Minorities - psychology; Sexually transmitted diseases; Specialization; STD; Tertiary Healthcare
• ISSN: 1464-2662; 1468-1293
• DOI: 10.1111/hiv.12645

Objectives We investigated the trend in usage of post‐exposure prophylaxis (PEP) after HIV‐1 risk exposure and evaluated PEP prescription decision making of physicians according to guidelines. Methods All PEP consultations from January 2014 to December 2016 in patients presenting at the University Hospital of Cologne (Germany) were retrospectively analysed. HIV risk contacts included sexual and occupational exposure. The European AIDS Clinical Society (EACS) Guidelines for HIV PEP (version 9.0, 2017) were used for assessment. Results A total of 649 patients presented at the emergency department (ED) or the clinic for infectious diseases (IDC) for PEP consultations. A continuous increase in the number of PEP requests was recorded: 189 in 2014, 208 in 2015 and 252 in 2016. PEP consultations in men who have sex with men (MSM) showed a remarkable increase in 2016 (2014, n = 96; 2015, n = 101; 2016, n = 152). Decisions taken by physicians with a specialization in infectious diseases (n = 547) included 61 (11%) guideline‐discordant prescriptions [2014: 14% (n = 22); 2015: 9% (n = 16); 2016: 11% (n = 23)]. Among these, sexual exposure accounted for 45 (74%) cases, including 15 cases of nonconsensual sex, while occupational exposure accounted for 14 (23%) cases and other exposure two cases (3%). The main reason for guideline‐discordant PEP prescriptions was emotional stress of the patient (n = 37/61). Conclusions PEP prescriptions are increasing and decision making is influenced by patients’ emotional stress, but PEP prescriptions should be strictly administered according to risk assessment.