Emergency AIDS Treatment After Unsafe Sex Might Help
Jan. 30, 2000 (San Francisco) -- Does it help or hurt AIDS prevention efforts to give anti-HIV drugs to people soon after unsafe sex? A study presented here at the 7th Conference on Retroviruses and Opportunistic Infections suggests that it can help -- provided the programs offer counseling along with the medication.
The CDC recommends post-exposure prophylaxis (PEP) for health-care workers and researchers accidentally exposed to HIV. Short-term AZT (zidovudine) also helps prevent transmission of the disease from an infected mother to her fetus. It is logical -- although it remains unproven -- that anti-HIV drugs can prevent infection when given to people within 72 hours of unprotected sex with a person known to have HIV or a behavioral risk for HIV infection.
But does the availability of PEP mean that people will see the drug treatment as a 'morning-after pill,' thereby increasing unsafe sex? Not if individuals seeking PEP are referred to a community program that provides risk-reduction counseling along with the pills, argues Michelle E. Roland, MD, who presented her study Sunday, the first day of the four-day HIV conference.
"We feel a tremendous sense of responsibility that PEP would have an [adverse] impact on the epidemic if the people we don't counsel rely [solely] on PEP," Roland tells WebMD. "But PEP preceded us -- and I am actually pretty proud of the way we've implemented our program. Many public health institutions now are responding to the demand for PEP and expanding to include a prevention component. We have transitioned [it] from a research to a clinical service."
In a 16-month study Roland; Jeffrey N. Martin, MD; and co-workers at the University of California, San Francisco (UCSF) and the San Francisco Department of Public Health monitored 401 people who had been exposed to HIV either sexually, via intravenous drug use, or other non-occupational exposure. The participants were enrolled and started on therapy within 72 hours of the exposure.
The program offered patients 28 days of anti-HIV drugs, usually AZT plus Epivir (lamivudine). In order to get the full course of the medications, patients also had to attend five counseling sessions. None of the patients developed HIV infection.
"We had strong statements in our informed consent [documentation indicating] that we did not know [whether] these drugs were effective, but 99% of participants accepted therapy and 78% completed all four weeks," Martin said during his part of the presentation. "There was a high rate of treatment compliance despite a high rate of adverse-event reporting," says Martin, referring to the sometimes crippling side effects associated with HIV therapy.
Martin, a researcher at UCSF, tells WebMD that the study proves there is a demand for PEP, and that people who need it can be identified and counseled, although the program attracted very few intravenous drug users. People with minimal exposures did not overwhelm the clinic -- probably because PEP is not a morning-after pill but rather four weeks of serious medication.