Experience of healthcare workers taking postexposure prophylaxis after occupational HIV exposures: Findings of the HIV postexposure prophylaxis registry

OBJECTIVE: To collect information about the safety of taking antiretroviral drugs for human immunodeficiency virus (HIV) postexposure prophylaxis (PEP ). DESIGN: A voluntary, confidential registry. SETTING: Hospital occupational health clinics, emergency departments, priva te physician offices, and health departments in the United States. RESULTS: 492 healthcare workers (HCWs) who had occupational exposures to HI V, were prescribed HN PEP, and agreed to be enrolled in the registry by the ir healthcare providers were prospectively enrolled in the registry. Three hundred eight (63%) of 492 of the PEP regimens prescribed for these HCWs co nsisted of at least three antiretroviral agents. Of the 449 HCWs for whom 6 -week follow-up was available, 195 (43%) completed the PEP regimen as initi ally prescribed. Forty-four percent (n = 197) of HCWs discontinued all PEP drugs and did not complete a PEP regimen. Thirteen percent (n = 57) discont inued greater than or equal to1 drug or modified drug dosage or added a dru g but did complete a course of PEP. Among the 254 HCWs who modified or disc ontinued the PEP regimen, the two most common reasons for doing so were bec ause of adverse effects attributed to PEP (54%) and because the source-pati ent turned out to be HIV-negative (38%). Overall, 340 (76%) HCWs with 6-wee k follow-up reported some symptoms while on PEP: nausea (57%), fatigue or m alaise (38%), headache (18%), vomiting (16%), diarrhea (14%), and myalgias or arthralgias (6%). The median time from start of PEP to onset of each of the five most frequently reported symptoms was 3 to 4 days. Only 37 (8%) HC Ws with 6-week follow-up were reported to have laboratory abnormalities; re view of the reported abnormalities revealed that most were unremarkable. Se rious adverse events were reported to the registry for 6 HCWs; all but one event resolved by the 6-month follow-up visit. Fewer side effects were repo rted by HCWs taking two-drug PEP regimens than by HCWs taking three-drug PE P regimens. CONCLUSIONS: Side effects from HIV PEP were very common but were rarely sev ere or serious. The nature and frequency of HN PEP toxicity were consistent with information already available on the use of these antiretroviral agen ts. Clinicians prescribing HIV FEP need to counsel HCWs about PEP side effe cts and should know how to manage PEP toxicity when it arises.