Emergency Department, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Rue Haute 322, 1000 Brussels, Belgium.
Infectious Diseases Department, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium.
J Infect. 2018 Jan;76(1):78-85. doi: 10.1016/j.jinf.2017.10.008. Epub 2017 Oct 23.
Non-occupational post-exposure prophylaxis (nPEP) is a recommended public health intervention after a sexual or percutaneous exposure to human immunodeficiency virus (HIV).
We conducted a prospective observational study recording consultations for nPEP at a reference HIV center in Brussels, Belgium from January 2011 to December 2015. We recorded attendance to follow-up, reported completion of nPEP and pharmacy records to measure adherence. Multivariate logistic regressions were performed to identify independent risk factors for adherence to nPEP and attendance to first follow-up visit at the STI clinic.
Among 1881 patients receiving nPEP, 66.4% had a documented completion of a 28-day course of nPEP and 87.3% attended their first follow-up clinic visit. MSM (OR, 1.40; 95%CI, 1.04-1.90), being a native Belgian (OR, 1.50; 95%CI, 1.18-1.90), older age (OR, 1.02; 95%CI, 1.01-1.04), being a sexual assault survivor (OR, 0.59; 95%CI, 0.38-0.91), having had a previous nPEP treatment (OR, 1.44; 95%CI, 1.02-2.02), consultation during daytime (OR, 1.35; 95%CI, 1.07-1.70) and benefitting from a health insurance (OR, 2.11; 95%CI, 1.58-2.89) were significant independent predictors for adherence to nPEP. Patients whose initial treatment was AZT/3TC/IDV/r had similar adherence than patients on d4T/3TC/LPV/r (OR, 0.898; 95%CI, 0.68-1.20).
Multiple independent risk factors for nPEP retention into care and adherence are present at treatment initiation and might be targeted by tailored interventions. Sexual assault victims are overexposed to deleterious consequences of the lack of health insurance on compliance.
非职业性接触后预防（nPEP）是在性或经皮接触人类免疫缺陷病毒（HIV）后推荐的公共卫生干预措施。
我们进行了一项前瞻性观察性研究，记录了 2011 年 1 月至 2015 年 12 月在比利时布鲁塞尔参考 HIV 中心进行的 nPEP 咨询。我们记录了随访的出席情况、报告的 nPEP 完成情况和药房记录，以衡量依从性。进行多变量逻辑回归以确定 nPEP 依从性和首次到性传播感染（STI）诊所就诊的独立危险因素。
在接受 nPEP 的 1881 名患者中，66.4%有记录表明完成了 28 天疗程的 nPEP，87.3%参加了他们的第一次随访诊所就诊。男男性接触者（MSM）（OR，1.40；95%CI，1.04-1.90）、比利时本地人（OR，1.50；95%CI，1.18-1.90）、年龄较大（OR，1.02；95%CI，1.01-1.04）、性侵犯幸存者（OR，0.59；95%CI，0.38-0.91）、有过 nPEP 治疗史（OR，1.44；95%CI，1.02-2.02）、白天就诊（OR，1.35；95%CI，1.07-1.70）和受益于健康保险（OR，2.11；95%CI，1.58-2.89）是依从 nPEP 的重要独立预测因素。初始治疗为 AZT/3TC/IDV/r 的患者与接受 d4T/3TC/LPV/r 治疗的患者依从性相似（OR，0.898；95%CI，0.68-1.20）。
在开始治疗时存在多个与 nPEP 保留在护理和依从性相关的独立危险因素，可能通过针对性的干预措施来靶向治疗。性侵犯受害者由于缺乏健康保险而面临更多的合规性不良后果。
