Paper Chase 5 – Non-Occupational HIV Prophylaxis

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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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Daniel S., MD -

National Clinicians Post-Exposure Prophylaxis Hotline (PEPline) telephone 888-448-4911 when necessary (9 am – 12 am EST seven days a week) ... does anyone have the hotline / information for the Stanford that was discussed ????

John L. -

I think your review implies that prophylaxis is not being offered appropriately to hi-risk sexual exposures. The study doesn't support this implication. It simply says " Physicians are more likely to give [not "offer"] postexposure HIV prophylaxis to patients with occupational exposure than nonoccupational exposures with high risk sexual exposure." It does not say anything about physicians "offering" prophylaxis. The risk of acquiring HIV from high risk sex cited in Up to Date during the study period was close to 1/1000. I have discussed this number with patients, and they have opted to not take the prophylaxis., given the very low likelihood that the would get HIV from this exposure. This pt population (hi-risk sex exposure) could be assumed to me more risk-accepting that the OJI needle stick pt. and , therefore, more likely to accept the low risk and decline the prophylaxis. This difference could easily account for the treatment difference (72% OJI vs 84% non OJI).
I think the point to be made is that the numbers should be discussed with the pt, so that they can make an informed decision.

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