Open Access2011 UK PEPSE guidelines: new incentive to document HIV‐1 serum viral load of patients’ HIV positive sexual partners
Author(s) -
Duncan S,
Pease E,
Morgan E,
Bennett A,
Morgan C,
Sherrard J
Publication year - 2012
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.7448/ias.15.6.18168
Subject(s) - medicine , medical prescription , viral load , transmission (telecommunications) , sexual transmission , men who have sex with men , human immunodeficiency virus (hiv) , cart , pre exposure prophylaxis , immunology , family medicine , syphilis , pharmacology , mechanical engineering , microbicide , electrical engineering , engineering
The 2011 UK guidelines for the prescription of Post‐Exposure Prophylaxis for the Prevention of HIV infection following Sexual Exposure (PEPSE) take account of the reduction in the risk of HIV transmission from an HIV‐positive individual who has an undetectable serum HIV‐1 viral load as a result of combination antiretroviral therapy (cART) [1]. Prescription of PEPSE is no longer routinely recommended for individuals who have had sex with a partner who is HIV‐positive and is known to have an undetectable serum HIV‐1 viral load on cART, unless unprotected receptive anal sex is reported. In this study we assessed how the application of the new UK PEPSE guidelines would alter PEPSE prescription in our region. We performed a retrospective case note‐review of all PEPSE prescriptions occurring between the 1st of January 2011 and the 31st of December 2011 in 4 sexual health clinics in the Oxford deanery (Oxford, Banbury, Reading and Slough). 91/ 96 PEPSE prescriptions were available for review. The mean age of each PEPSE recipient was 30.3 years; 71/91 (78%) of recipients were male, of whom 54/71 (76%) were men who have sex with men (MSM). 63/91 (69%) of PEPSE recipients were of white UK ethnicity. In 32/91 (35%) of cases, the patient reported having sex with a partner was known to be HIV‐positive. Of these, 10/32 (31%) reported that their partner was taking antiretroviral therapy, and 4/10 (40%) of this group reported that their partner had an undetectable serum HIV‐1 viral load. Thus of 91 PEPSE prescriptions, 4 (4%) occurred in patients reporting sex with HIV‐positive partners who were taking antiretroviral therapy and had an undetectable HIV‐1 serum viral load: receptive anal sex was reported in 1 case, and vaginal sex in the remaining 3 cases. Despite a significant change in the UK PEPSE guidelines, in only 3/91 cases in which PEPSE was previously given would prescription no longer be recommended. 32/91 patients reported sex with an HIV‐positive partner, and the HIV‐1 viral load was either unknown or not documented in the majority of cases. It may not be possible to corroborate a patient's report of their partner's HIV‐1 viral load in all cases; thus PEPSE will still be required. However, the new PEPSE guidelines increase the incentive for all clinicians to actively seek and accurately document the HIV‐1 viral load of patients' HIV‐positive sexual partners.