Analysis of 10 Years of nPEP in Seattle: High Prescription Rates for Those at Lower Risk of HIV
This retrospective chart review of 360 patients who were evaluated for non-occupational post-exposure prophylaxis (nPEP) for HIV at one Seattle HIV clinic between 2000 and 2010 found that only 31% of the 324 patients prescribed nPEP were considered "high risk." The study, which was published in PLOS One, defined "high risk" as men who have sex with men (MSM) who presented for care within 72 hours of potential exposure to HIV and had had unprotected receptive anal intercourse with someone who was HIV infected or whose HIV status was unknown.
The U.S. Centers for Disease Control and Prevention issued guidelines for nPEP in 2005. However, in this study, two-thirds of patients with an exposure that didn't meet these guidelines were still prescribed nPEP. The study authors acknowledge "that clinicians faced with a frightened patient and vague guidelines often prescribe nPEP treatment in cases of low transmission risk, illustrating the difficulty of caring for patients exposed to HIV." They conclude, "Patients and clinicians would benefit from more detailed guidelines for provision of nPEP as exposure to HIV is often charged with fear that overwhelms rational assessments of risk."
More than 2,000 MSM were diagnosed with HIV in (Seattle's) King County between 2001-2010, yet only 111 MSM requested nPEP for high-risk exposure during that time at this clinic. Study authors also cited European and U.S. surveys, including one conducted between 2009-2012 at the Seattle Gay Pride Parade, that show low awareness of nPEP among at-risk populations.
They conclude, "In order for nPEP to have a population-level impact on HIV prevention, education and promotion must be intensified and targeted to groups who would benefit most from nPEP: MSM who have unprotected receptive anal intercourse."