Background: Postexposure prophylaxis (PEP) has been used to decrease a risk of HIV transmission after occupational exposure. Regimen completion is one of the most important factors in successful prophylaxis. Limited data are available on tolerability of PEP regimens in healthcare workers (HCWs) in resource-limited settings. We aimed to describe the characteristics of occupational exposure, and sought to determine factors associated with incompletion of the 4-week HIV prophylactic course.
Methods: A retrospective study was conducted among HCWs who accidentally exposed to blood or body fluid of patients at Bamrasnaradura Infectious Diseases Institute, Thailand, between March 1996 and June 2014. The characteristics of exposure were described, and logistic regression analysis was used to determine factors associated with incompletion of the 4-week prophylactic course.
Results: A total of 225 exposure episodes were reported (163 percutaneous injury, 43 mucosal exposure, 6 non-intact skin exposure, and 13 intact skin exposure). The mean (SD) age was 33.1 (9.9) years and 189 (84%) were females. The most frequently exposed groups were nurses (43%), patient or nurse assistants (18%), and medical technicians (15%). The HIV status of the source was defined in 149 (66%) episodes which were positive in 101 (68%). Of 225 exposures, PEP was prescribed in 155 (69%) episodes but was subsequently intentionally discontinued in 26 episodes (HIV source was negative in 19, refusal to continue in 7). PEP courses should have completed in 129 episodes. Of 129 prescribed regimens, 38% were 2 NRTIs, 37% were 2 NRTIs + PIs, 12% were Zidovudine alone, 9% were 2 NRTIs + Efavirenz (EFV), and 4% were 2 NRTIs + Raltegravir. Only 91 of 129 (71%) HCWs were able to complete the 4-week regimen. Multivariate analysis showed that 2 NRTIs + EFV was the only significant factor associated with incompletion of the 4 week-course (OR 33.3; 95% CI 4.2-100; p < 0.01). Other factors including age, gender, staff position, status of the source, and other PEP regimens were not associated with incompletion of the 4-week course (p > 0.05). The reason for premature discontinuation of 2 NRTIs + EFV was intolerability in all HCWs. None of the HCWs was reported to have HIV seroconversion.
Conclusions: Two NRTIs + EFV regimen was significantly associated with premature discontinuation of occupational PEP. This regimen should not be further used for HIV prophylaxis following occupational exposure in the resource-limited settings.