The use of a triple nucleoside-nucleotide regimen for nonoccupational HIV post-exposure prophylaxis

Authors

  • A Winston,

    1. Department of Immunology, HIV and Infectious Diseases, St Vincent's Hospital, Sydney, Australia, and
    2. National Centre for HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia
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  • J McAllister,

    1. Department of Immunology, HIV and Infectious Diseases, St Vincent's Hospital, Sydney, Australia, and
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  • J Amin,

    1. National Centre for HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia
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  • DA Cooper,

    1. Department of Immunology, HIV and Infectious Diseases, St Vincent's Hospital, Sydney, Australia, and
    2. National Centre for HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia
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  • A Carr

    1. Department of Immunology, HIV and Infectious Diseases, St Vincent's Hospital, Sydney, Australia, and
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Dr Alan Winston, National Centre for HIV Epidemiology and Clinical Research, 376 Victoria Street, Sydney, NSW 2010, Australia. Tel:+612 93850906; fax:+612 93850910; e-mail: awinston@nchecr.unsw.edu.au

Abstract

Objectives

Nonoccupational post-exposure prophylaxis (NPEP) for HIV is recommended after high-risk sexual exposure. Because of the high incidence of intolerable side effects observed with protease inhibitor- and zidovudine-based NPEP regimens, our unit changed standard NPEP treatment to 28 days of tenofovir-lamivudine-stavudine (TDF-3TC-d4T). The aim of this study was to compare side effects and numbers of individuals completing NPEP before and after this change.

Methods

Parameters were compared amongst individuals commencing the following NPEP regimens: zidovudine-lamivudine (ZDV-3TC), zidovudine-lamivudine-nelfinavir (ZDV-3TC-NFV) and TDF-3TC-d4T.

Results

A total of 385 individuals received ZDV-3TC (n=36), ZDV-3TC-NFV (n=225) or TDF-3TC-d4T (n=137) as NPEP for the first time between June 1999 and November 2003. Noncompletion rates were 25%, 32% and 15%, respectively (P=0.001), with odds ratios for noncompletion being 2.0 [95% confidence interval (CI) 0.8–4.8] and 2.7 (95% CI 1.6–4.8) in the first two groups compared with the TDF-3TC-d4T group (P=0.008). Adverse events were less common in the TDF-3TC-d4T group, with significantly lower rates of nausea and headache, but significantly higher rates of peripheral neuropathy and asymptomatic raised transaminases. There was no HIV seroconversion in any group.

Conclusions

TDF-3TC-d4T is significantly better tolerated than ZDV-3TC or ZDV-3TC-NFV as NPEP and results in greater numbers of individuals completing 28 days of treatment.

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