Head of Emergency Department, University Hospital of Bichat, París, Francia. Infection Antimicrobials Modelling Evolution (IAME) research center, UMR 1137 - INSERM. University of Paris, Faculty of Medicine Denis Diderot, París, Francia.
Infection Antimicrobials Modelling Evolution (IAME) research center, UMR 1137 - INSERM. University of Paris, Faculty of Medicine Denis Diderot, París, Francia.
Emergencias. 2021 Feb;33(1):35-41.
The efficacy of postexposure prophylaxis (PEP) after human immunodeficiency virus (HIV) contact relies on administering the treatment within 4 hours of contact with the virus. This study aimed to evaluate predictors of the time that elapses between HIV exposure and emergency department arrival.
Prospective observational study carried out at Hôpital Bichat, a university teaching hospital in Paris, France. All emergency visits for occupational or nonoccupational exposure to HIV in 2016 and 2017 were included.
A total of 1475 cases were studied; 598 patients responded to the follow-up survey. A delay of 4 hours or more between HIV exposure and the emergency department visit was associated with type of contact: health care occupational exposure, other occupational exposure, or sexual intercourse (P .001). We found significant differences between individuals exposed during sexual contact versus occupational exposure with respect to knowledge of the PEP program pathway (65.2% vs 46.9%, respectively), previous use of PEP (23.9% vs 13.1%), alcohol intake (36.2% vs 18.5%), drug use (34.6% vs 8.6%), and chemsex (sexualized drug use) (26.1% vs 0%) (P .001, all comparisons). Predictors of time until start of PEP among individuals exposed during sexual intercourse were knowledge and prior use of the PEP pathway (P .001), drug use (P = .03), and chemsex (P .001). Predictors among occupationally exposed individuals were prior knowledge of the PEP pathway and drug use (P .001).
Delay in seeking PEP after HIV exposure is greater among individuals exposed during sexual intercourse. Knowledge of the PEP program and prior use of it are associated with less delay. Exposure during sexual intercourse, alcohol and drug use, and chemsex are associated with longer delays, especially in men who have sex with men.
人类免疫缺陷病毒（HIV）接触后暴露后预防（PEP）的疗效依赖于在接触病毒后 4 小时内给予治疗。本研究旨在评估 HIV 暴露与急诊科就诊之间时间间隔的预测因素。
这是在法国巴黎比沙医院进行的一项前瞻性观察性研究。纳入了 2016 年和 2017 年所有因职业或非职业接触 HIV 而就诊的急诊患者。
共研究了 1475 例病例；598 例患者对随访调查做出了回应。HIV 暴露与急诊科就诊之间的延迟 4 小时或更长时间与接触类型有关：医疗职业暴露、其他职业暴露或性行为（P.001）。我们发现，在性接触暴露与职业暴露的个体之间，在 PEP 方案途径的知晓情况（分别为 65.2%和 46.9%）、之前使用 PEP（23.9%和 13.1%）、饮酒（36.2%和 18.5%）、药物使用（34.6%和 8.6%）和化学性行为（药物辅助性行为）（26.1%和 0%）方面存在显著差异（P.001，所有比较）。在性行为暴露的个体中，开始使用 PEP 的时间预测因素是对 PEP 途径的了解和先前使用情况（P.001）、药物使用（P =.03）和化学性行为（P.001）。在职业暴露个体中，PEP 途径的先前了解和药物使用是预测因素（P.001）。
在性行为暴露后寻求 PEP 的延迟时间在性接触暴露的个体中更大。对 PEP 方案的了解和先前使用情况与延迟时间较短有关。性接触、酒精和药物使用以及化学性行为与较长的延迟时间有关，尤其是男男性行为者。
