人类免疫缺陷病毒（HIV）的暴露后预防

摘要/Abstract

摘要： 未感染HIV者在职业过程中或职业场所以外,如非保护性性行为,性侵害,共用针头,针刺伤以及创伤等,与HIV感染者的血液、组织、体液或HIV污染的器械及设备等接触,都有感染HIV的危险。HIV暴露后预防用于对于无HIV感染的暴露者,在暴露后72小时内尽快开始应用3种抗逆转录病毒药物,疗程28天能有效预防HIV感染。推荐抗病毒效果最佳的方案中,选择耐受性好,且服药方便的方案。首选2NRTIs+整合酶抑制剂。暴露者需要对HIV状态,药物副反应等进行规律监测。

关键词: HIV, 暴露后预防, 方案

Abstract: Persons with exposure to blood, genital secretions, or other potentially infectious body fluids that might contain human immunodeficiency virus (HIV) in or outside health care settings may face the risk for HIV acquisition.Post exposure prophylaxis (PEP) is indicated for exposed persons without HIV infection. All persons offered PEP should be prescribed a 28-day course of a 3-drug antiretroviral regimen within 72 hours after exposure. Antiretrovirals that effectively suppress viral replication with good tolerance and convenience are recommended for PEP. 2NRTIs and 1INSTI are preferred. Evaluations including HIV Ag/Ab and monitor of safety or toxicities related to the regimen prescribed are required.

Key words: HIV, PEP, Scheme

王芳, 张福杰. 人类免疫缺陷病毒（HIV）的暴露后预防[J]. 新发传染病电子杂志, 2019, 4(2): 121-124.

WANG Fang, ZHANG Fu-jie. Post exposure prophylaxis for human immunodeficiency virus (HIV)[J]. Electronic Journal of Emerging Infectious Diseases, 2019, 4(2): 121-124.

参考文献

[1] Goldschmidt RH, et al.CDC Releases Updated Guidelines for Postexposure Prophylaxis After Sexual, Injection Drug, or Other Nonoccupational Exposures to HIV[J]. Am Fam Physician, 2016, 94(5):392-393.
[2] 中国疾病预防控制中心性病艾滋病预防控制中心. 国家免费艾滋病抗病毒药物治疗手册(第四版)[M]. 北京:人民卫生出版社,2016,18-25.
[3] Cardo DM, Culver DH, Ciesielski CA, et al.A case-control study of HIV seroconversion in health care workers after percutaneous exposure[J]. New Engl J Med, 1997, 337(21):1485-1490.
[4] Tsai CC, Emau P, Follis KE, et al.Effectiveness of postinoculation (R)-9-(2-phosphonylmethoxypropyl) adenine treatment for prevention of persistent simian immunodeficiency virus SIVmne infection depends critically on timing of initiation and duration of treatment[J]. J Virol, 1998, 72(5):4265-4273.
[5] Otten RA, Smith DK, Adams PR, et al.Efficacy of postexposure prophylaxis after intravaginal exposure of pig-tailed macaques to a human-derived retrovirus (human immunodeficiency virus type 2)[J]. J Virol, 2000, 74(20):9771-9775.
[6] Irvine C, Egan KJ, Shubber Z, et al.Efficacy of HIV Postexposure Prophylaxis: Systematic Review and Meta-analysis of Nonhuman Primate Studies[J]. Clin Infect Dis, 2015, 60(3): S165-169.
[7] Pinkerton SD, Martin JN, Roland ME, et al.Cost-effectiveness of postexposure prophylaxis after sexual or injection-drug exposure to human immunodeficiency virus[J]. Arch Intern Med, 2004, 164(1):46-54.
[8] Lurie P, Miller S, Hecht F, et al.Postexposure prophylaxis after nonoccupational HIV exposure: clinical, ethical, and policy considerations[J]. JAMA, 1998, 280(20):1769-1773.
[9] Claydon E, Murphy S, Osborne EM, et al.Rape and HIV[J]. Int J STD AIDS, 1991, 2(3):200-201.
[10] Myles JE, Hirozawa A, Katz MH, et al.Postexposure prophylaxis for HIV after sexual assault[J]. JAMA, 2000, 284(12):1516-1518.
[11] Fong C.Post-exposure prophylaxis for HIV infection after sexual assault: when is it indicated?[J]. Emerg Med J, 2001, 18(4):242-245.
[12] Tsai CC, Follis KE, Sabo A, et al.Prevention of SIV infection in macaques by (R)-9-(2-phosphony lmethoxypropyl)adenine[J]. Science, 1995, 270(5239):1197-1199.
[13] Le Grand R, Vaslin B, Larghero J, et al.Post-exposure prophylaxis with highly active antiretroviral therapy could not protect macaques from infection with SIV/HIV chimera[J]. AIDS, 2000, 14(12):1864-1866.
[14] Bourry O, Brochard P, Souquiere S, et al.Prevention of vaginal simian immunodeficiency virus transmission in macaques by postexposure prophylaxis with zidovudine, lamivudine and indinavir[J]. AIDS, 2009, 23(4):447-454.
[15] Dobard C, Sharma S, Parikh UM, et al.Postexposure protection of macaques from vaginal SHIV infection by topical integrase inhibitors[J]. SciTransl Med, 2014, 6(227):1-9.
[16] Ryom L, Boesecke C, Bracchi M, et al.Highlights of the 2017 European AIDS Clinical Society (EACS) Guidelines for the treatment of adult HIV-positive persons version 9.1[J]. Hiv Medicine, 2018, 19(5):23-27.
[17] World Health Organization.Updated recommendations on first-line and second-line antiretroviral regimens and post-exposure prophylaxis and recommendations on early infant diagnosis of HIV: interim guidelines[EB/OL]. http://www.who.int/iris/handle/10665/273632. Licence: CC BY-NC-SA 3.0 IGO.
[18] Mayer KH, Mimiaga MJ, Cohen D, et al.Tenofovir DF plus lamivudine or emtricitabine for nonoccupationalpostexposure prophylaxis (NPEP) in a Boston community health center[J]. J Acquir Immune DeficSyndr, 2008, 47(4):494-499.
[19] Mayer KH, Mimiaga MJ, Gelman M, et al.Raltegravir, tenofovir DF, and emtricitabine for postexposure prophylaxis to prevent the sexual transmission of HIV: safety, tolerability, and adherence[J]. J Acquir Immune DeficSyndr, 2012, 59(4):354-359.
[20] Malinverni S, Libois A, Gennotte AF, et al.Prescription of Non-Occupational Post-Exposure HIV Prophylaxis by Emergency Physicians: An Analysis on Accuracy of Prescription and Compliance[J]. PLoS One, 2016, 11(4):e0153021.
[21] Bryant J, Baxter L, Hird S, et al.Non-occupational postexposure prophylaxis for HIV: a systematic review[J]. Health Technol Assess, 2009, 13(14):1-60.
[22] Schechter M, do Lago RF, Mendelsohn AB, et al. Behavioral impact, acceptability, and HIV incidence among homosexual men with access to postexposure chemoprophylaxis for HIV[J]. J Acquir Immune DeficSyndr, 2004, 35(5):519-525.
[23] Rhee SY, Blanco JL, Jordan MR, et al.Geographic and temporal trends in the molecular epidemiology and genetic mechanisms of transmitted HIV-1 drug resistance: an individual-patient- and sequence-level meta-analysis[J]. PloS Med, 2015, 12(4):1-29.
[24] Donnell D, Mimiaga MJ, Mayer K, et al.Use of non-occupational post-exposure prophylaxis does not lead to an increase in high risk sex behaviors in men who have sex with men participating in the EXPLORE trial[J]. AIDS Behav, 2010, 14(5):1182-1189.
[25] Golub SA, Rosenthal L, Cohen DE, et al.Determinants of high-risk sexual behavior during post-exposure prophylaxis to prevent HIV infection[J]. AIDS Behav, 2008, 12(6):852-859.
[26] Martin JN, Roland ME, Neilands TB, et al.Use of postexposure prophylaxis against HIV infection following sexual exposure does not lead to increases in high-risk behavior[J]. AIDS, 2004, 18(5):787-792.
[27] Waldo CR, Stall RD, Coates TJ.Is offering post-exposure prevention for sexual exposures to HIV related to sexual risk behavior in gay men?[J]. AIDS, 2000, 14(8):1035-1039.
[28] Heuker J, Sonder GJB, Stolte I, et al.High HIV incidence among MSM prescribed postexposure prophylaxis, 2000-2009: indications for ongoing sexual risk behaviour[J]. AIDS, 2012, 26(4):505-512.
[29] van Der Snoek EM, de Wit JB, Mulder PG, et al. Incidence of sexually transmitted diseases and HIV infection related to perceived HIV/AIDS threat since highly active antiretroviral therapy availability in men who have sex with men[J]. Sex Transm Dis, 2005, 32(3):170-175.
[30] Poynten IM, Jin F, Mao L, et al.Nonoccupational postexposure prophylaxis, subsequent risk behaviour and HIV incidence in a cohort of Australian homosexual men[J]. AIDS, 2009, 23(9):1119-1126.
[31] Loke WC, Conway K, Kulasegaram R.The impact of taking HIV post-exposure prophylaxis after sexual exposure (PEPSE) on sexual behaviour[J]. HIV Med, 2010, 11(Suppl 1):52.