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Characteristics of human immunodeficiency virus exposure and predictors of time until access to postexposure prophylaxis: a prospective observational study

Casalino E, Bouzid D, Antoniol S, Pinto A, Choquet C, Pereira L, Pavlovsky T, Ing V, Yazdanpanah Y, Ghosn J, Ghazali DA

Head of Emergency Department, University Hospital of Bichat, París, France. Infection Antimicrobials Modelling Evolution (IAME) research center, UMR 1137 – INSERM. University of Paris, Faculty of Medicine Denis Diderot, París, France. Infectious Diseases Department, University Hospital of Bichat París, France.

Background and objective. The efficacy of postexposure prophylaxis (PEP) after human immunodeficiency virus (HIV) contact relies on administering the treatment within 4 hours of contact with the virus. This study aimed to evaluate predictors of the time that elapses between HIV exposure and emergency department arrival.
Methods. Prospective observational study carried out at Hôpital Bichat, a university teaching hospital in Paris, France. All emergency visits for occupational or nonoccupational exposure to HIV in 2016 and 2017 were included.
Results. A total of 1475 cases were studied; 598 patients responded to the follow-up survey. A delay of 4 hours or more between HIV exposure and the emergency department visit was associated with type of contact: health care occupational exposure, other occupational exposure, or sexual intercourse (P < .001). We found significant differences
between individuals exposed during sexual contact versus occupational exposure with respect to knowledge of the PEP program pathway (65.2% vs 46.9%, respectively), previous use of PEP (23.9% vs 13.1%), alcohol intake (36.2% vs 18.5%), drug use (34.6% vs 8.6%), and chemsex (sexualized drug use) (26.1% vs 0%) (P < .001, all comparisons).
Predictors of time until start of PEP among individuals exposed during sexual intercourse were knowledge and prior use of the PEP pathway (P < .001), drug use (P = .03), and chemsex (P < .001). Predictors among occupationally exposed individuals were prior knowledge of the PEP pathway and drug use (P < .001).
Conclusions. Delay in seeking PEP after HIV exposure is greater among individuals exposed during sexual intercourse. Knowledge of the PEP program and prior use of it are associated with less delay. Exposure during sexual intercourse, alcohol and drug use, and chemsex are associated with longer delays, especially in men who have sex with men.

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