Postexposure prophylaxis: HIV PReP alternative option for select patients

Takeaway

• Postexposure prophylaxis-in-pocket (PIP) may be a valuable preventative option for patients with low frequency of high-risk HIV exposures.

Why this matters

• Consider PIP as an alternative to preexposure prophylaxis (PrEP) for a select group of patients with infrequent high-risk HIV exposure.
• PIP is best for patients with high reliability, health literacy, and self-awareness characteristics.
• Regular follow-up ensures patients are on some type of HIV prevention strategy.

Key results

• 79 patients prescribed PIP; 94.9% (75) men who have sex with men; mean age, 37.5 (range, 21-70) years.
• Mean PIP duration, 14.8 months; 40.5% had previously used PrEP.
• 26.6% (21) initiated 32 PIP courses.
• 100% of courses initiated ≤72 hours postexposure; self-reported 28 days adherence=100%.
• No HIV seroconversions on subsequent testing.
• Clinic follow-up rate, 91.1%.
• Prior PrEP use was not prognostic for initiating PIP.
• Patients initiating PIP >1 time were significantly more likely to switch modality from PIP to daily PrEP (P=.02).

Study design

• Retrospective multicenter cohort analysis evaluating long-term follow-up of patient-initiated PIP for primary HIV prevention.
• Funding: Canadian Institutes of Health Research.

Limitations

• Small sample size.
• Retrospective.
• No control group.
• Limited generalizability.