是否开具处方：HIV-1 暴露后预防决策。

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

机构信息

Department I of Internal Medicine, University of Cologne, Cologne, Germany.

German Center for Infection Research (DZIF) Partner Site Bonn-Cologne, Cologne, Germany.

出版信息

HIV Med. 2018 Oct;19(9):645-653. doi: 10.1111/hiv.12645. Epub 2018 Jul 11.

DOI:10.1111/hiv.12645

PMID:29993176

Abstract

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.

摘要

目的

我们调查了 HIV-1 风险暴露后使用暴露后预防（PEP）的趋势，并根据指南评估了医生开具 PEP 处方的决策。

方法

回顾性分析了 2014 年 1 月至 2016 年 12 月在德国科隆大学医院就诊的所有 PEP 咨询患者。HIV 风险接触包括性接触和职业接触。评估使用了欧洲艾滋病临床学会（EACS）HIV PEP 指南（第 9.0 版，2017 年）。

结果

共有 649 名患者在急诊科（ED）或传染病诊所（IDC）就诊进行 PEP 咨询。PEP 请求的数量持续增加：2014 年 189 例，2015 年 208 例，2016 年 252 例。与男性发生性关系的男性（MSM）的 PEP 咨询在 2016 年显著增加（2014 年，n = 96；2015 年，n = 101；2016 年，n = 152）。具有传染病专业知识的医生做出的决定（n = 547）包括 61 例（11%）不符合指南的处方[2014 年：14%（n = 22）；2015 年：9%（n = 16）；2016 年：11%（n = 23）]。其中，性接触占 45 例（74%），包括 15 例非自愿性行为，职业接触占 14 例（23%），其他接触 2 例（3%）。不符合指南的 PEP 处方的主要原因是患者的情绪压力（n = 37/61）。