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Postexposure prophylaxis after sexual exposure to HIV

Roland, Michelle E

Current Opinion in Infectious Diseases: February 2007 - Volume 20 - Issue 1 - p 39–46
doi: 10.1097/QCO.0b013e328012c5e0
HIV infection and AIDS
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Purpose of review HIV postexposure prophylaxis is often recommended following potential sexual exposure to HIV. Recent data address the effectiveness of postexposure prophylaxis and prevention counseling, cost-effectiveness, antiretroviral options, challenges with nonoccupational postexposure prophylaxis among adolescents and children and following sexual assault in high HIV prevalence areas, and a successful program in Amsterdam.

Recent findings Postexposure prophylaxis is not completely protective. Seroconversion may result from antiretroviral failure or from ongoing exposures. Postexposure prophylaxis associated risk reduction counseling results in reductions in subsequent risk behavior. Programs that target outreach and limit prescriptions to those with exposure sources who are at risk of being HIV infected are cost-effective. Less restrictive guidelines result in more prescriptions for low-risk exposures; this practice is not cost-effective. The ideal antiretrovirals for postexposure prophylaxis use have not been established. Tenofovir has several attractive properties. Developing systems to support the effective delivery of postexposure prophylaxis among children and adolescents and following sexual assault in high HIV prevalence, resource limited settings is challenging.

Summary Numerous national and international guidelines recommend postexposure prophylaxis following potential sexual exposure to HIV. Maximizing adherence and minimizing subsequent HIV exposures will be critical to enhancing the effectiveness of this HIV prevention intervention.

Positive Health (AIDS) Program at San Francisco General Hospital, University of California, San Francisco, California, USA

Correspondence to Michelle E. Roland, MD, Positive Health Program, University of California at San Francisco, Ward 84, San Francisco General Hospital, 995 Potrero Avenue, San Francisco, CA 94110, USA Tel: +1 415 476 4082 ext 432; fax: +1 415 476 6953; e-mail: mroland@php.ucsf.edu

© 2007 Lippincott Williams & Wilkins, Inc.