November 17, 2010
The current study's authors compared two HIV postexposure prophylaxis (PEP) regimens for safety, outcome, and follow-up among men who have sex with men (MSM) in Amsterdam.
From 2000, all MSM beginning HIV PEP have been followed in one location. The PEP regimen was zidovudine or lamivudine and nelfinavir (regimen 1) until 2005. Thereafter, PEP consisted of zidovudine or lamivudine and atazanavir (regimen 2). From 2000 to 2007, patient data including side effects and alanine aminotransferase (ALT) were systematically recorded and compared by regimen.
PEP was prescribed 309 times to MSM, and 261 MSM were followed up. Of the 261 MSM, 237 (91 percent) completed the 28-day course of PEP. Fewer patients experienced diarrhea on regimen 2 than regimen 1, though the completion rate was the same - 98 of 110 (89 percent) for regimen 2, and 139 of 151 (92 percent) for regimen 1.
Just one patient with severely elevated ALT was advised to stop PEP; he also had serious illness. MSM over age 30 and MSM whose partners were known to be HIV-positive completed PEP significantly more often than MSM under 30 and MSM with sex partners of unknown serostatus. Of PEP completers, five seroconverted despite good adherence. None of the five were resistant to the PEP regimen used.
"No difference in adherence was found between the two regimens, even though fewer adverse events were reported on regimen 2," the study authors reported. "ALT need not be routinely tested to monitor adverse effects. The five seroconversions were not likely caused by PEP failure, but rather ongoing HIV exposures."
Sexually Transmitted Diseases
11.2010; Vol. 37; No. 11: P. 681-686; Gerard J.B. Sonder, Jan M. Prins, Rosa M. Regez, Kees Brinkman, Jan-Willem Mulder, Jan Veenstra, Frans A.P. Claessen, Anneke van den Hoek
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