The care of individuals exposed to HIV remains a challenge regarding post-exposure prophylaxis (PEP) completion and is a unique occasion of sexual counseling. Identifying risks of not fulfilling PEP course and concomitant condom use among individuals demanding PEP may improve clinical practice.
Retrospective analysis from the French National Dat’AIDS cohort (NCT02898987) of individuals evaluated for PEP between 2004 and 2017. We assessed clinically relevant predictors (Odd-ratios [OR] and 95% Credibility Interval) and their probabilities (Pr) of both non-condom use and PEP premature interruption (< 20 days) by Bayesian modeling.
Overall, 48947 potential exposures to HIV were evaluated for PEP, 19887 for occupational and 29060 for sexual risks. Participants were primarily male (54%) with a median age of 30 years (IQR, 24-39). The source had an unknown HIV serostatus in 38743 exposures. Among the 29060 sexual exposures (36% MSM versus 64% heterosexual), 48% reported non-condom use during the exposure. Non-condom use increased (Pr > 99%) with the year of exposure (OR per 10-years increment, 1.22 [1.14-1.29]), MSM (OR, 1.33 [1.16-1.53]) and rape (OR, 12.3 [10.6-14.3]). Non-condom use decreased (Pr > 99%) with age (OR per 10-years increment, 0.90 [0.88-0.93]), in the case of an intercourse with a sex worker (OR, 0.33 [0.29-0.36]), or a woman partner (OR, 0.83 [0.72-0.95]), and knowledge of the serological status of the partner, whether positive (OR, 0.79 [0.73-0.86]); or negative (OR, 0.84 [0.73-0.95]). Overall, 22 402 individuals (46%) effectively received PEP (14% occupational and 86% sexual exposures). PEP regimens varied among time (Figure). Overall, 20% of individuals discontinued their PEP regimen within 20 days. Age (OR, 0.87 per 10-years increment [0.83-0.92]), MSM (OR, 0.59 [0.47-0.73]), intercourse with a sex worker (OR, 0.41 [0.31-0.51]), rape (OR, 0.41 [0.32-0.53]), moderate depth of occupational accident (OR, 0.76 [0.58-0.98]) versus deep and superficial), and known HIV-infected source patient (OR, 0.50 [0.42-0.59]), were factors associated with reduced risks of PEP early discontinuation (Pr > 98%). Neither PEP regimen nor reported condom use were associated with a premature PEP stop.
Our study provides new insights for targeting groups of individuals with specific interventions, for improving both condom use and PEP completion. Especially Youth and MSM need more targeted interventions in risk behavior prevention and adherence.