EAGA guidelines

In September 2008 the Expert Advisory Group on AIDS (EAGA) issued an updated version of its own detailed best-practice guidance for the Department of Health.¹ The guidance primarily covers occupational exposure in healthcare workers. In relation to sexual exposure, the EAGA endorsed the BASHH guidelines.

EAGA notes the following data from the Health Protection Agency’s voluntary registry of PEP following occupational exposure:

• Eighteen per cent of healthcare workers (HCWs) chose not to take PEP even after significant exposure to a confirmed HIV-positive source;
• Thirty-eight per cent of HCWs started PEP within an hour of exposure and only 3% after 72 hours;
• Only 58% of HCWs were reported to have undergone HIV post-exposure testing, and 46% completed the recommended 24 weeks of follow-up. (In the light of this, and because there has never been a case of late seroconversion following PEP in a HCW, the guidance revised its post-PEP follow-up requirement to twelve weeks.)

The guidance also recommends NRTI plus PI combination therapy for PEP, rejecting the US guidelines’ two-drug regimens for ‘lower-risk’ exposures as confusing.

As in the BHIVA guidelines, the EAGA guidance recommends one once-daily Truvada tablet plus two twice-daily Kaletra tablets as the preferred PEP regimen, and recommends that clinics and A&E departments keep starter packs of these. However Combivir (AZT plus 3TC) is recommended as a second NRTI option. They add that “other NRTI and PI combinations could be used where the physician considers them more appropriate for individual patients. Other new classes of drugs, such as entry inhibitors and integrase inhibitors, may have a role in cases of resistant source virus, but there is currently no evidence for their use in this situation.”

The guidance warns staff and patients to be aware of the short-term side-effects of the recommended drugs, particularly diarrhoea, and of possible drug interactions primarily caused by the ritonavir component of Kaletra.