Evaluating counseling outcome on adherence to prophylaxis and follow-up after sexual HIV-risk exposure: a randomized controlled trial.

L. Bentza, P. Enelb, B. Dunaisa, J. Durantc, I. Poizot-Martind, C. Tourette-Turgis, M. Rébillone, F. LeDuffa, P. Dellamonicac, C. Pradier

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Observance Thérapeutique

2010

Vol. 22, No. 12, December 2010

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Since 1998, recommendations have been put forward in the USA and Europe for the management of accidental viral-risk exposure, namely through sexual transmission. According to the level of risk, these recommendations advise a standard 28-day post exposure prophylaxis (PEP). This consists in a triple drug regimen including either three nucleoside analogs or a combination of two nucleoside analogs and a protease inhibitor. Certain guidelines also recommend standardized follow-up of PEP and HIV serostatus at least up to the third month following exposure (Almeda et al., 2004; Center for Disease Control [CDC], 2005; Fisher et al., 2006; Yeni, 2006). PEP must be initiated within a short delay but recipients are unprepared to cope with a complex treatment regimen and its side effects, which may interfere with treatment adherence (Duran & the APROCO Cohort Study Group, 2001; Laporte et al., 2002; Lot, Larsen, & Herida, 2007; Yeni, 2006). Difficulty in adhering to follow-up may lead to ineffective prophylaxis and undiagnosed HIV seroconversion. To date, completion of PEP treatment and follow-up remains controversial. Several studies reported low adherence on both treatment and follow-up (Day, Mears, Bond, & Kulasegaram, 2006; Luque et al., 2007; Mayer et al., 2008; Rey et al., 2008), while others showed satisfying rates (Kahn et al., 2001; Lacombe et al., 2006; Sonder et al., 2007). In France, PEP is free of charge and available in every hospital and low adherence jeopardizes its cost-effectiveness (Pinkerton et al., 2004).