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Abstract
Background Postexposure prophylaxis (PEP) is a recommended public health intervention after a sexual assault to prevent HIV infection.
Methods We conducted a retrospective case-control study on how use of a single-tablet regimen (STR) of elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (Stribild) affected adherence to PEP and attendance of a follow-up visit to the STI clinic compared with those who received a multitablet regimen (MTR). Data from sexual assault victims consulting for PEP were prospectively recorded between January 2011 and December 2017. Data were systematically collected on patient demographics, time of medical contact, source risk factors, type of exposure, attendance to follow-up visit, reported completion of PEP and adherence based on pharmacy records.
Results A total of 422 patients received PEP following a sexual assault, of whom 52% had documented completion of a 28-day PEP regimen and 71% attended a follow-up clinic visit. Patients who received an elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (EVG/COBI/FTC/TDF)-based STR had a similar likelihood of attending their first follow-up visit (OR: 0.97; 95% CI: 0.64 to 1.48, p=0.90) but were more likely to complete the PEP regimen (OR: 1.70; 95% CI: 1.16 to 2.50, p=0.007). After adjusting for confounders, those who were prescribed an STR regimen were more likely to complete the PEP regimen (OR: 1.66, 95% CI: 1.09 to 2.53, p=0.019) than those who were prescribed an MTR such as stavudine/lamivudine/lopinavir/ritonavir or zidovudine/lamivudine/indinavir/ritonavir.
Conclusions Sexual assault victims who were prescribed an STR based on EVG/COBI/FTC/TDF were more likely to complete PEP than those who were prescribed an MTR.
- adherence
- antiretroviral therapy
- sexual assault
- postexposure prophylaxis (HIV)
- sexual abuse
Data availability statement
Data are available in the following public, open access repository: 10.6084/m9.figshare.13108370.
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Data availability statement
Data are available in the following public, open access repository: 10.6084/m9.figshare.13108370.
Footnotes
Handling editor Anna Maria Geretti
Contributors SM made substantial contributions to the conception of the work, the acquisition, analysis and interpretation of data for the work. Drafted the work, gave the final approval of the version to be published and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. FB made substantial contributions to the acquisition and interpretation of data; critically revised the work for important intellectual content, gave the final approval of the version to be published and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MB, CG, SDW and AL made substantial contributions to the interpretation of data for the work, critically revised the work for important intellectual content, gave the final approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests SDW reports grants from Gilead, grants from Janssens, grants from MSD, grants from ViiV, outside the submitted work. AL reports grants from Gilead, grants from Janssens, grants from ViiV, outside the submitted work.
Provenance and peer review Not commissioned; externally peer reviewed.