The story behind blocking HIV exposure consultants is the secret to improving the success rate of blocking

For medical professionals only

Post-exposure prophylaxis (PEP) refers to a method by which a person who has not yet been infected with human immunodeficiency virus (HIV) takes specific antiviral drugs within 72 hours after a person with HIV infection or an uninformed person has developed HIV-susceptible ^behaviors[1

Some people figuratively call PEP "taking regret medicine"

In this PEP case, the counselor was a 26-year-old male who went to the hospital 7 hours after the male man had anal sex without a condom and asked to implement PEP

The standardized PEP suitability assessment for consultants is as follows:

1) Exposure time: 7 hours (< 72 hours).

2) Risk of exposure: The counselor has unprotected anal sex with an HIV-positive person who has not received antiviral therapy, and the counselor is the inserted party and has the risk

Based on the above assessment, the hospital believes that the consultant meets the criteria for

The results of the counselor's follow-up at weeks 2, 4, 8, 12, and 24 are as follows:

Figure 1: Counselors followed up with changes in alanine aminotransferase (ALT) and aspartate aminotransferase (AST).

Figure 2: Counselors followed up with changes in serum creatinine (Cr) and glomerular filtration rate (eGFR).

Figure 3: Counselors followed up with changes in total cholesterol (CH), triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL).

Table 1: Patients followed up with changes in HIV, TPPA/RPR, HBV, and HCV

Attending physician
of the Department of Infectious Diseases of Guiyang Public Health Treatment Center.

Member of Guizhou Aids Diagnosis and Treatment Quality Control Center, Member of Guizhou Aids and Venereal Disease Association; Youth Member of AIDS Prevention and Control Branch of Chinese Association of
Traditional Chinese Medicine.

Engaged in AIDS diagnosis and treatment for 7 years, has rich clinical experience in AIDS diagnosis and treatment, and has participated in training and learning on AIDS diagnosis and treatment in the province and abroad for many times; Repeatedly preached HIV/AIDS prevention and treatment knowledge in major cities/prefectures, districts and counties designated hospitals in Guizhou; Participate in the national "13th Five-Year Plan" major special project research
.

The Chinese GUIDELINEs for THE DIAGNOSIS AND TREATMENT OF HIV (2021 Edition) defines PEP as a biological method
to reduce the risk of HIV infection by taking specific anti-HIV drugs as early as possible (no more than 72 hours) after exposure to a high risk of infection, such as a clear body fluid exchange behavior with an HIV-infected person or a person whose infection status is unknown.

According to the above definition, it is recommended that consultants initiate PEP as early as possible (preferably within 24 hours, no more than 72 hours), continuous medication (28 days), standardized medication (complete triple antiviral regimen), and simple, safe, well-tolerated and cost-effective combination mono tablets are preferred for
PEP.

BIC/FTC/TAF is a complete antiviral triple monolithic formulation composed of potent backbone drugs (FTC/TAF) and innovative integrase inhibitors (BIC), and is the only monolithic blocking protocol
recommended by the China AIDS Diagnosis and Treatment Guidelines (2021 Edition).

In this case, the two parties were tested with HIV test paper after unprotected contact, one of which was positive and the other was negative, and the risk of exposure was high
.

Due to the timely initiation of the PEP program and good medication compliance, a satisfactory blocking effect
was also obtained.

▌ Why do I do the blocking within 72 hours of exposure? What should I do if it takes more than 72 hours?

After the human body is exposed to HIV percutaneously or mucous membranes, local replication of the virus occurs in
tissue macrophages or dendritic cells.

If it is not controlled at this stage, HIV will replicate in the regional lymph nodes within 48 to 72 hours, and viremia will subsequently occur within 72 to 120 hours (3 to 5 days) ^[3
].

It is recommended that people at high risk of HIV infection follow up regularly to improve HIV screening, and if infected with HIV, seek medical treatment
as soon as possible.

▌What factors need to be considered in the choice of blocking scheme?

The factors to be considered in the selection of blocking schemes are: (1) the blocking effect; (2) Drug resistance problems (selection of drugs with high resistance barrier; If the source of exposure is an HIV-resistant strain or a suspected drug-resistant strain, a specialist needs to be consulted to determine the PEP regimen); (3) The use of antiviral therapy drugs of the exposure source; (4) Drug side effects; (5) Medication compliance of the consultant; (6) The economic situation of the
consultant.

▌What are the issues that need attention in communicating with PEP consultants?

(1) First avoid re-occurrence of high-risk behaviors, and correctly apply protective measures
such as condoms when it is not clear whether they are infected.

(2) Some consultants may have hepatitis B, because the program contains anti-hepatitis B virus drugs, it is recommended to consult a hepatologist after the end of the blockade, and formulate the next step of the treatment plan to avoid hepatitis B virus rebound
.

(3) The success of blocking is inseparable from good medication compliance, and it is necessary to explain to the consultant the importance of taking medication on time every day to avoid missing and delaying taking
.

(4) If the consultant is taking other drugs or health care products at the same time during the blocking period, it is necessary to be vigilant against the interaction between drugs and drugs to avoid affecting the blocking effect
.

Director
of the Department of Infection, Guiyang Public Health Treatment Center.

Master tutor of Guizhou Medical University, master tutor of School of Public Health of Peking University
.

Guiyang "City Management Expert"
.

Member of the Standing Committee of the AIDS Professional Group of the Infectious Disease Hospital Branch of the Chinese Hospital Association; Member of China Association for the Prevention and Control of STDs and AIDS, Member of the Professional Committee of AIDS and Opportunistic Infection, Member of the Professional Committee of HIV Combined Tuberculosis; Member of the Standing Committee of the Intensive Care Group of the Tuberculosis Branch of the Chinese Medical Association; Member of the Standing Committee of the Tuberculosis and AIDS Dual Infection Professional Committee of the Chinese Antituberculosis
Association.

Deputy Leader of the Expert Group of Guizhou Provincial AIDS Diagnosis and Treatment Quality Control Center; Member of the Standing Committee of the Infectious Diseases Branch of Guizhou Medical Association; Director of Guizhou Antituberculosis Association; Member of the Standing Committee of infectious disease branch of Guiyang Medical Association; Leader of Guiyang AIDS Diagnosis and Treatment Quality Control Expert Group; Vice President of Guiyang AIDS and Venereal Disease Prevention and Control Association; Visiting Scholar
, National Clinical Research Center, Naples, Italy.

He was awarded the title
of "Advanced Individual" in The Fight against the Covid-19 Epidemic in Guizhou Province.

The blocking plan selects the compound monolithic formulation recommended by the Chinese AIDS Diagnosis and Treatment Guidelines (2021 Edition), which has the following advantages:

(1) Guideline recommendation: The 2021 version of the China guidelines only recommends a monolithic blocking scheme, and the 2021 EACS guidelines also recommend BIC/FTC/TAF for PEP ^[4].

(2) Easy to take, high completion rate: 28 days high completion rate
.

An open-label, prospective study conducted at the Community Health Center in Boston, USA, showed that the BIC/FTC/TAF monolithic blocking regimen was much higher than that of the other two regimens ^compared with previous PEP combinations (AZT/3TC+PI, FTC/TDF+RAL
).

(3) Good safety, less occurrence of adverse events: The above studies show that the incidence of adverse events in the BIC/FTC/TAF monolithic blocking scheme is also much lower than that of the previous PEP combination scheme (AZT/3TC+PI, FTC/TDF+RAL).


Compared with various regimens, the incidence of adverse reactions such as nausea/vomiting, fatigue, diarrhea/stools, headache, dizziness/dizziness, and myalgia/arthralgia was significantly lower in counselors taking BIC/FTC/TAF, and no vertigo/dizziness was found ^{in the consultants [5}
].

(4) Potency: BIC/FTC/TAF is a complete antiviral triple monolithic formulation
composed of potent backbone drugs (FTC/TAF) and innovative integrase (BIC).

In men with repeated PEP applications and a persistent risk of HIV exposure (MSM), it is recommended to consider switching to pre-exposure prophylaxis
(PrEP).

PEP should be started within 72 hours of exposure to HIV, and the earlier it starts, the better
.

BIC/FTC/TAF combination mono tablets are convenient, safe and effective, and well tolerated, and are the preferred regimen
for PEP consultants.

[1] Hepatitis C Group of HIV/AIDS, Infectious Diseases Branch of Chinese Medical Association, Chinese Center for Disease Control and Prevention, Chinese AIDS Diagnosis and Treatment Guidelines (2021 Edition)[J].
Chinese AIDS and Venereal Diseases,2021,27(11):1182-1201.

Yang Xinyu.
Applications and challenges of AIDS pre-exposure prevention and post-exposure prevention[J].
Chinese AIDS STDs,2019,25(04):425-428.

[3] Elliot DeHaan, MD.
Rationale for PEP and Evidence of PEP Effectiveness.
August 11, 2022.

#tab_2

[4] European AIDS Clinical Society.
Guidelines ver 9.
1.
Oct,2018 P12.

[5] Mayer KH,et al.
J Acquir Immune Defic Syndr.
2022 Jan 4.