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California Task Force on Non-Occupational PEP and the California Department of Health Services Office of AIDS. Offering HIV postexposure prophylaxis (PEP) following nonoccupational exposures: recommendations for healthcare providers in the state of California. Sacramento, California; 2004.
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Madrid, Spain: Ediciones Doyma;, 2002
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Almeda J, Casabona J, Simon B, et al. Guidelines for nonoccupational postexposure HIV prophylaxis: recommendations of GESIDA/CEESCAT/National plan on AIDS. In: Practice guidelines for the management of HIV infections (2000-2002). Madrid, Spain: Ediciones Doyma; 2002. pp. 129-142.
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Nonoccupational HIV PEP Task Force, Brown University AIDS Program and the Rhode Island Department of Health, Brown University AIDS Program and the Rhode Island Department of Health;
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UK guideline for the use of postexposure prophylaxis for HIV following sexual exposure
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Fisher M, Benn P, Evans B, et al. UK guideline for the use of postexposure prophylaxis for HIV following sexual exposure. Int J STDAIDS 2006; 17:81-92.
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Two drugs or three? Balancing efficacy, toxicity, and resistance in postexposure prophylaxis for occupational exposure to HIV
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Bassett IV, Freedberg KA, Walensky RP. Two drugs or three? Balancing efficacy, toxicity, and resistance in postexposure prophylaxis for occupational exposure to HIV. Clin Infect Dis 2004; 39:395-401.
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Patel SM, Johnson S, Belknap SM, et al. Serious adverse cutaneous and hepatic toxicities associated with nevirapine use by non-HIV-infected individuals. J Acquir Immune Defic Syndr 2004; 35:120-125.
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Rabaud C, Burty C, Grandidier M, et al. Tolerability of postexposure prophylaxis with the combination of zidovudine-lamivudine and lopinavir-ritonavir for HIV infection. Clin Infect Dis 2005; 40:303-305. Prospective study of zidovudine plus lamivudine plus lopinavir/ritonavir for PEP in 121 patients. Twenty discontinued PEP due to side effects and 38 of 78 who completed the course had adverse effects. The authors concluded that this regimen may be better tolerated than previous study regimens containing indinavir or nelfinavir.
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Rabaud C, Burty C, Grandidier M, et al. Tolerability of postexposure prophylaxis with the combination of zidovudine-lamivudine and lopinavir-ritonavir for HIV infection. Clin Infect Dis 2005; 40:303-305. Prospective study of zidovudine plus lamivudine plus lopinavir/ritonavir for PEP in 121 patients. Twenty discontinued PEP due to side effects and 38 of 78 who completed the course had adverse effects. The authors concluded that this regimen may be better tolerated than previous study regimens containing indinavir or nelfinavir.
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Tolerance of a short course of nevirapine, associated with 2 nucleoside analogues, in postexposure prophylaxis of HIV
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Rey D, Partisani M, Hess-Kempf G, et al. Tolerance of a short course of nevirapine, associated with 2 nucleoside analogues, in postexposure prophylaxis of HIV. J Acquir Immune Defic Syndr 2004; 37:1454-1456.
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Rey, D.1
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Van Rompay KK, Kearney BP, Sexton JJ, et al. Evaluation of oral tenofovir disoproxil fumarate and topical tenofovir GS-7340 to protect infant macaques against repeated oral challenges with virulent simian immunodeficiency virus. J Acquir Immune Defic Syndr 2006; 43:6-14. Oral tenofovir pre and postexposure use in infant macaque monkeys was partially effective in preventing SIV transmission following repeated oral exposures meant to mimic breast-feeding HIV exposures. Topical tenofovir was not effective.
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Van Rompay KK, Kearney BP, Sexton JJ, et al. Evaluation of oral tenofovir disoproxil fumarate and topical tenofovir GS-7340 to protect infant macaques against repeated oral challenges with virulent simian immunodeficiency virus. J Acquir Immune Defic Syndr 2006; 43:6-14. Oral tenofovir pre and postexposure use in infant macaque monkeys was partially effective in preventing SIV transmission following repeated oral exposures meant to mimic breast-feeding HIV exposures. Topical tenofovir was not effective.
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Winston A, McAllister J, Amin J, et al. The use of a triple nucleoside-nucleotide regimen for nonoccupational HIV postexposure prophylaxis. HIV Med 2005; 6:191-197. This observational study compared side effects and completion rates in individuals using three different PEP regimens as the standard practice evolved over time. Side effect and completion rates were best with the most recent combination, lamivudine plus stavudine plus tenofovir. This group was compared with individuals using first zidovudine plus lamivudine and then zidovudine plus lamivudine plus nelfinavir. Peripheral neuropathy was reported with stavudine use. This was not a randomized, controlled trial.
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Winston A, McAllister J, Amin J, et al. The use of a triple nucleoside-nucleotide regimen for nonoccupational HIV postexposure prophylaxis. HIV Med 2005; 6:191-197. This observational study compared side effects and completion rates in individuals using three different PEP regimens as the standard practice evolved over time. Side effect and completion rates were best with the most recent combination, lamivudine plus stavudine plus tenofovir. This group was compared with individuals using first zidovudine plus lamivudine and then zidovudine plus lamivudine plus nelfinavir. Peripheral neuropathy was reported with stavudine use. This was not a randomized, controlled trial.
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Roland ME, Neilands TB, Krone MR, et al. Seroconversion following nonoccupational postexposure prophylaxis against HIV. Clin Infect Dis 2005; 41:1507-1513. Seroconversion was documented at 3 months in seven of 702 individuals who initiated PEP. Some may have resulted from ongoing exposures and others from failure of PEP to prevent HIV infection.
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Roland ME, Neilands TB, Krone MR, et al. Seroconversion following nonoccupational postexposure prophylaxis against HIV. Clin Infect Dis 2005; 41:1507-1513. Seroconversion was documented at 3 months in seven of 702 individuals who initiated PEP. Some may have resulted from ongoing exposures and others from failure of PEP to prevent HIV infection.
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Use of postexposure prophylaxis against HIV infection following sexual exposure does not lead to increases in high-risk behavior
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Martin JN, Roland ME, Neilands TB, et al. Use of postexposure prophylaxis against HIV infection following sexual exposure does not lead to increases in high-risk behavior. Aids 2004; 18:787-792.
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Martin, J.N.1
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Neilands, T.B.3
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discussion 191-192, This editorial comment raised the concern that providing PEP following consensual sexual exposures may be harmful by causing erosion of primary prevention strategies such as condom use
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Richens J, Edwards SG, Sadiq ST. Can the promotion of postexposure prophylaxis following sexual exposure to HIV (PEPSE) cause harm? Sex Transm Infect 2005; 81:190-191; discussion 191-192.. This editorial comment raised the concern that providing PEP following consensual sexual exposures may be harmful by causing erosion of primary prevention strategies such as condom use.
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Can the promotion of postexposure prophylaxis following sexual exposure to HIV (PEPSE) cause harm? Sex Transm Infect
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Richens, J.1
Edwards, S.G.2
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Schechter M, do Lago RF, Mendelsohn AB, et al. Behavioral impact, acceptability, and HIV incidence among homosexual men with access to postexposure chemoprophylaxis for HIV. J Acquir Immun Defic Syndr 2004; 35:519-525.
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Pinkerton SD, Martin JN, Roland ME, et al. Cost-effectiveness of postexposure prophylaxis after sexual or injection-drug exposure to human immunodeficiency virus. Arch Intern Med 2004; 164:46-54.
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Braitstein P, Chan K, Beardsell A, et al. Prescribing practices in a population-based HIV postexposure prophylaxis program. AIDS 2002; 16:1067-1070.
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Herida M, Larsen C, Lot F, et al. Cost-effectiveness of HIV postexposure prophylaxis in France. AIDS 2006; 20:1753-1761. French guidelines have resulted in increased prescribing of PEP, often following exposures when the source is not likely to be HIV infected. These prescribing practices have resulted in a program that is not cost-effective.
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Herida M, Larsen C, Lot F, et al. Cost-effectiveness of HIV postexposure prophylaxis in France. AIDS 2006; 20:1753-1761. French guidelines have resulted in increased prescribing of PEP, often following exposures when the source is not likely to be HIV infected. These prescribing practices have resulted in a program that is not cost-effective.
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Postexposure prophylaxis after nonoccupational HIV exposure: Impact of recommendations on physicians' experiences and attitudes
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Laporte A, Jourdan N, Bouvet E, et al. Postexposure prophylaxis after nonoccupational HIV exposure: impact of recommendations on physicians' experiences and attitudes. AIDS 2002; 16:397-405.
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Merchant RC, Keshavarz R. Emergency prophylaxis following needle-stick injuries and sexual exposures: results from a survey comparing New York Emergency Department practitioners with their national colleagues. Mt Sinai J Med 2003; 70:338-343.
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Christofides NJ, Muirhead D, Jewkes RK, et al. Women's experiences of and preferences for services after rape in South Africa: interview study. BMJ 2006; 332:209-213. This study examined factors that women valued with regard to sexual assault services in urban and rural South Africa. Access to PEP, with or without HIV testing, a sensitive healthcare provider, and follow-up for counseling were most important. Women were less concerned about travel and waiting time if the services were of high quality. They preferred that all medications be dispensed at the initial visit.
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Christofides NJ, Muirhead D, Jewkes RK, et al. Women's experiences of and preferences for services after rape in South Africa: interview study. BMJ 2006; 332:209-213. This study examined factors that women valued with regard to sexual assault services in urban and rural South Africa. Access to PEP, with or without HIV testing, a sensitive healthcare provider, and follow-up for counseling were most important. Women were less concerned about travel and waiting time if the services were of high quality. They preferred that all medications be dispensed at the initial visit.
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Garcia MT, Figueiredo RM, Moretti ML, et al. Postexposure prophylaxis after sexual assaults: a prospective cohort study. Sex Transm Dis 2005;32:214-219. PEP was initiated quickly in a prospective study of sexual assault survivors in Sao Paulo, Brazil. A two-drug regimen was prescribed for moderate-risk exposures and a three-drug regimen for high-risk exposures. Two-drug regimens were associated with higher completion rates and fewer side effects, although without randomization it cannot be concluded that other factors, including higher levels of emotional distress, did not contribute to this difference.
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Garcia MT, Figueiredo RM, Moretti ML, et al. Postexposure prophylaxis after sexual assaults: a prospective cohort study. Sex Transm Dis 2005;32:214-219. PEP was initiated quickly in a prospective study of sexual assault survivors in Sao Paulo, Brazil. A two-drug regimen was prescribed for moderate-risk exposures and a three-drug regimen for high-risk exposures. Two-drug regimens were associated with higher completion rates and fewer side effects, although without randomization it cannot be concluded that other factors, including higher levels of emotional distress, did not contribute to this difference.
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Speight CG, Klufio A, Kilonzo SN, et al. Piloting postexposure prophylaxis in Kenya raises specific concerns for the management of childhood rape. Trans R Soc Trop Med Hyg 2006; 100:14-18. This paper described the early experiences with a Kenyan PEP program. Unanticipated high rates of child sexual assault victims have raised concerns about pediatric dosing and the psychological needs of healthcare providers. Poor follow-up rates will require modifications in the service delivery system.
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Speight CG, Klufio A, Kilonzo SN, et al. Piloting postexposure prophylaxis in Kenya raises specific concerns for the management of childhood rape. Trans R Soc Trop Med Hyg 2006; 100:14-18. This paper described the early experiences with a Kenyan PEP program. Unanticipated high rates of child sexual assault victims have raised concerns about pediatric dosing and the psychological needs of healthcare providers. Poor follow-up rates will require modifications in the service delivery system.
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Templeton DJ, Davies SC, Garvin AL, Garsia RJ. The uptake of HIV postexposure prophylaxis within a sexual assault setting in Sydney, Australia. Int J STD AIDS 2005; 16:108-111. Report of PEP use in a sexual assault service in Sydney between 1999 and 2000 reports extremely low rates of offering PEP.
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Templeton DJ, Davies SC, Garvin AL, Garsia RJ. The uptake of HIV postexposure prophylaxis within a sexual assault setting in Sydney, Australia. Int J STD AIDS 2005; 16:108-111. Report of PEP use in a sexual assault service in Sydney between 1999 and 2000 reports extremely low rates of offering PEP.
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Hachey M, van As AB. HIV postexposure prophylaxis in victims of child sexual abuse. Ann Emerg Med 2005; 46:97-98. Delays in PEP initiation for children in Cape Town resulted from the initial presentation at a police station or healthcare facility that did not provide PEP. The authors propose that PEP should be broadly available in the health sector. Facilitating PEP initiation with a stat dose and then making appropriate referral for further assessment and follow up is important. Upcoming WHO guidelines will address these issues.
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Hachey M, van As AB. HIV postexposure prophylaxis in victims of child sexual abuse. Ann Emerg Med 2005; 46:97-98. Delays in PEP initiation for children in Cape Town resulted from the initial presentation at a police station or healthcare facility that did not provide PEP. The authors propose that PEP should be broadly available in the health sector. Facilitating PEP initiation with a stat dose and then making appropriate referral for further assessment and follow up is important. Upcoming WHO guidelines will address these issues.
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Use of human immunodeficiency virus postexposure prophylaxis in adolescent sexual assault victims
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Adolescent sexual assault survivors seen in urban US emergency departments frequently had a prior psychiatric diagnosis and were unlikely to follow up or complete PEP regimens
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Olshen E, Hsu K, Woods ER, et al. Use of human immunodeficiency virus postexposure prophylaxis in adolescent sexual assault victims. Arch Pediatr Adolesc Med 2006; 160:674-680. Adolescent sexual assault survivors seen in urban US emergency departments frequently had a prior psychiatric diagnosis and were unlikely to follow up or complete PEP regimens.
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Cardo DM, Culver DH, Ciesielski CA, et al. A case-control study of HIV seroconversion in healthcare workers after percutaneous exposure. Centers for Disease Control and Prevention Needlestick Surveillance Group. N Engl J Med 1997; 337:1485-1490.
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Gray GE, Urban M, Chersich MF, et al. A randomized trial of two postexposure prophylaxis regimens to reduce mother-to-child HIV-1 transmission in infants of untreated mothers. AIDS 2005; 19:1289-1297. Seroconversion rates were reduced when antiretrovirals were provided to infants whose HIV-infected mothers did not receive any pre or intrapartum antiretroviral treatment as compared with historical seroconversion rates in the absence of any antiretroviral use in mothers or infants.
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Gray GE, Urban M, Chersich MF, et al. A randomized trial of two postexposure prophylaxis regimens to reduce mother-to-child HIV-1 transmission in infants of untreated mothers. AIDS 2005; 19:1289-1297. Seroconversion rates were reduced when antiretrovirals were provided to infants whose HIV-infected mothers did not receive any pre or intrapartum antiretroviral treatment as compared with historical seroconversion rates in the absence of any antiretroviral use in mothers or infants.
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Tsai CC, Emau P, Follis KE, et al. Effectiveness of postinoculation (R)-9-(2-phosphonylmethoxypropyl) adenine treatment for prevention of persistent simian immunodeficiency virus SIVmne infection depends critically on timing of initiation and duration of treatment. J Virol 1998; 72:4265-4273.
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Kahn JO, Martin JN, Roland ME, et al. Feasibility of postexposure prophylaxis (PEP) against human immunodeficiency virus infection after sexual or injection drug use exposure: the San Francisco PEP Study. J Infect Dis 2001; 183:707-714.
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11 July, Barcelona, Spain
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Roland MNT, Krone M, Frances K, et al. A randomized trial of standard versus enhanced risk reduction counseling for individuals receiving postexposure prophylaxis following sexual exposures to HIV. In: 13th Conference on Retroviruses and Opportunistic Infections; 5-8 February 2006; Denver, Colorado.
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Serious adverse events attributed to nevirapine regimens for postexposure prophylaxis after HIV exposures - worldwide, 1997-2000. MMWR Morb Mortal Wkly Rep 2001; 49:1153-1156.
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Cressey TR, Jourdain G, Lallemant MJ, et al. Persistence of nevirapine exposure during the postpartum period after intrapartum single-dose nevirapine in addition to zidovudine prophylaxis for the prevention of mother-to-child transmission of HIV-1. J Acquir Immune Defic Syndr 2005; 38:283-288. Single-dose nevirapine in HIV-infected pregnant women resulted in suppressive levels in the majority of women for over a week.
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Cressey TR, Jourdain G, Lallemant MJ, et al. Persistence of nevirapine exposure during the postpartum period after intrapartum single-dose nevirapine in addition to zidovudine prophylaxis for the prevention of mother-to-child transmission of HIV-1. J Acquir Immune Defic Syndr 2005; 38:283-288. Single-dose nevirapine in HIV-infected pregnant women resulted in suppressive levels in the majority of women for over a week.
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Jackson JB, Barnett S, Piwowar-Manning E, et al. A phase I/II study of nevirapine for preexposure prophylaxis of HIV-1 transmission in uninfected subjects at high risk. AIDS 2003; 17:547-553.
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