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Regimens often changed: hotline steers HIV-exposed clinicians to proper prophylaxis.(Gynecology)
SAN FRANCISCO -- If you get exposed to HIV at work, calling a free 24-hour hotline for expert advice can help you choose the right medications with the least toxicity, even if you've already started prophylaxis, according to a recent study.
The National Clinicians' Post-Exposure Prophylaxis Hotline (PEPline) has received more than 45,000 calls to its toll-free number (888-448-4911) since its inception in 1997. About 21% of these involved health care workers potentially exposed to HIV from patients with the disease. Even though the U.S. Public Health Service established standards of practice to prevent HIV infection in health care workers exposed to an HIV-infected source patient, some cases require expert interpretation to decide on the best approach for prophylaxis.
In a review of 244 calls made between April 1, 2002, and March 31, 2003, in which the viral load and the CD4 count of the HIV-positive source patient were known, clinicians already had started a postexposure prophylactic antiretroviral regimen in 121 cases, 3 of which were deemed nonexposures by PEPline staff. The PEPline experts recommended changing the prophylactic regimen in 46% of the remaining 118 cases, Betty J. Dong, Pharm.D., said in a poster presentation at the 11th Conference on Retroviruses and Opportunistic Infections.
PEPline experts recommended increasing the number of antiretroviral medications in 19% of cases, decreasing the number of drugs in 12%, keeping the same number of drugs but choosing different antiretrovirals in 8%, and unspecified changes in the rest, said Dr. Dong of the University of California, San Francisco.
The number of antiretroviral medications increased with higher viral loads in the source patients. The source patient's CD4 count did not affect the number of prophylactic drugs recommended to health care workers, she said at the meeting, sponsored by the Foundation for Retrovirology and Human Health.
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