  
National guidelines for nonoccupational HIV postexposure prophylaxis needed
Last Updated: 2001-04-13 11:31:45 EDT (Reuters Health)
WESTPORT, CT (Reuters Health) - Fewer than half of hospital emergency departments in Massachusetts have written or unwritten protocols for providing nonoccupational HIV postexposure prophylaxis (PEP) to patients who request it, survey results show.
"Because nonoccupational PEP takes place in more complicated situations, such as sexual assault, and involves patients who are not directly linked with healthcare settings...providing PEP regimens with adequate counseling, support and followup requires special planning," study director Dr. Laureen M. Kunches noted in an interview with Reuters Health.
Studies show that with appropriate support, up to 78% of patients can achieve full compliance with PEP recommendations, she said.
Dr. Kunches, who is affiliated with JSI Research and Training Institute, Inc. in Boston, and a multicenter team surveyed the medical directors of 66 of 78 hospital emergency departments in Massachusetts. They asked about the number of requests for nonoccupational PEP in the past year and the protocols for delivering this service.
Nearly one third of the emergency departments reported having received at least one request for nonoccupational PEP in the prior year, according to the team's report in the March 1st issue of the Journal of Acquired Immune Deficiency Syndromes. However, only 15% had formal, written protocols for delivering the prophylaxis. An additional 33% of emergency departments reported having unwritten protocols.
The majority of protocols, written or unwritten, recommended the use of two nucleoside analogues and a protease inhibitor. Forty-one percent of emergency departments with any type of protocol reported having approved more than one drug regimen for nonoccupational PEP.
In their journal report, the investigators express hope that the new findings will inform the development of national, evidence-based guidelines for nonoccupational PEP.
Until formal guidelines are produced, Dr. Kunches reminds physicians that "it is critical to initiate PEP medications promptly following exposure--the sooner the better, but [definitely] within 36 to 72 hours."
J Acquir Immune Defic Syndr 2001;26:263-265.
-Westport Newsroom 203 319 2700
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