Daniel J. Pallin, MD, MPH reviewing O'Donnell S et al. Ann Emerg Med 2016 Apr 21.

A retrospective study finds that the opportunity to provide postexposure prophylaxis in the emergency department is missed more often after nonoccupational exposures.

Postexposure prophylaxis (PEP) for HIV infection is indicated when healthcare is sought within 72 hours of a high-risk exposure to a body fluid known to transmit HIV. Investigators at a Canadian emergency department compared adherence to recommended practices in the management of patients with occupational and nonoccupational exposures. Sexual assaults were excluded.

Of 1972 patient encounters, 69% had occupational exposure and 31% had nonoccupational exposure. Among high-risk exposures, 84% of patients with occupational exposure versus 73% of those with nonoccupational exposure were appropriately given prophylaxis, a significant difference. For low-risk exposures, appropriate management (prophylaxis not given) was similar in occupational and nonoccupational exposures (92% and 93%). Among the 28% of patients who had follow-up testing within 6 months, none with occupational exposure had seroconverted, compared with 2% with nonoccupational exposure. Of the four patients who seroconverted, prophylaxis was indicated in all four and administered in two.

Citation(s):

O'Donnell S et al. Missed opportunities for HIV prophylaxis among emergency department patients with occupational and nonoccupational body fluid exposures. Ann Emerg Med 2016 Apr 21; [e-pub].

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