56 Dean Street, HIV, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
56 Dean Street, HIV, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
Sex Transm Infect. 2022 Dec;98(8):595-598. doi: 10.1136/sextrans-2021-055277. Epub 2022 Feb 15.
HIV-1 pre-exposure prophylaxis (PrEP) has been available in England since March 2020 on the National Health Service using generic emtricitabine and tenofovir disoproxil. 56 Dean Street (56DS) provided PrEP through (1) additional private care from September 2015, estimated to be providing 11% of England's PrEP in 2019; and (2) the IMPACT trial, as well as monitoring those self-sourcing PrEP. Providing PrEP at scale through a nurse-led service required a safety net for complex individuals. 56DS introduced a consultant-led PrEP outpatient service, the PrEP review clinic, in January 2018 and we report the outcomes of this service.
We present a retrospective case note review of the PrEP review clinic with descriptive outcomes from 26 January 2018 to 20 December 2019. Reason for referral, demographics, PrEP management and PrEP discontinuations were recorded.
13 980 unique users accessed PrEP from 56DS during the two year evaluation period. 220 individuals were seen in the PrEP review clinic. Majority of patients were referred for renal issues (114 of 220, 51.8%), followed by side effects (59 of 220, 26.8%) and comorbidities (38 of 220, 17.2%). Of those with renal issues, 89 (out of 114, 78.1%) users were referred for an abnormal estimated glomerular filtration rate (eGFR). 35 (out of 114, 30.7%) PrEP users had an eGFR between 45 and 59 mL/min/1.73 m, of whom 2 (5.7%) discontinued PrEP. Majority of users were advised to stop supplements±switch to event-based dosing (24 of 35, 68.6%). Ten PrEP users were referred with an eGFR between 30 and 44 mL/min/1.73 m; 4 (40%) stopped or did not start PrEP and 6 (60%) were asked to stop supplements±switch to event-based dosing.
A small proportion of PrEP users have complex PrEP issues. Methods to manage renal dysfunction with PrEP included stopping supplements and switching to event-based dosing. Those with side effects were managed with an array of options, with only modest effectiveness. Other PrEP options are needed to support those with toxicities or intolerances.
自 2020 年 3 月起，英国国民保健署开始提供 HIV-1 暴露前预防（PrEP），采用通用的恩曲他滨和替诺福韦酯双异丙醇胺。56 号Dean 街（56DS）从 2015 年 9 月开始通过（1）额外的私人护理，预计在 2019 年提供英国 PrEP 的 11%；和（2）IMPACT 试验，以及监测那些自行获取 PrEP 的人。通过护士主导的服务大规模提供 PrEP 需要为复杂的个体提供安全网。56DS 在 2018 年 1 月引入了一个由顾问主导的 PrEP 门诊服务，即 PrEP 审查诊所，我们报告了该服务的结果。
我们对 2018 年 1 月 26 日至 2019 年 12 月 20 日期间 PrEP 审查诊所的病例记录进行了回顾性病例分析。记录了转诊原因、人口统计学特征、PrEP 管理和 PrEP 停药情况。
在两年的评估期间，有 13980 名独特的用户从 56DS 获得 PrEP。有 220 名患者在 PrEP 审查诊所就诊。大多数患者因肾脏问题（220 例中的 114 例，51.8%），其次是副作用（220 例中的 59 例，26.8%）和合并症（220 例中的 38 例，17.2%）而转诊。在肾脏有问题的患者中，89 名（114 名中的 89 名，78.1%）患者的肾小球滤过率（eGFR）异常。35 名（114 名中的 35 名，30.7%）PrEP 用户的 eGFR 在 45 至 59ml/min/1.73m 之间，其中 2 名（5.7%）停止了 PrEP。大多数患者被建议停止补充剂±切换至基于事件的剂量（35 名中的 24 名，68.6%）。有 10 名 PrEP 用户的 eGFR 在 30 至 44ml/min/1.73m 之间；4 名（40%）停止或未开始 PrEP，6 名（60%）被要求停止补充剂±切换至基于事件的剂量。
一小部分 PrEP 用户存在复杂的 PrEP 问题。管理 PrEP 相关肾功能障碍的方法包括停止补充剂并切换至基于事件的剂量。有副作用的患者采用了一系列方法治疗，效果相当温和。需要其他 PrEP 方案来支持那些有毒性或不耐受的患者。
