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Emergency AIDS Treatment After Unsafe Sex Might Help

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"We feel that the PEP setting may be a means of identifying persons difficult to reach with standard risk-reduction interventions," Martin says. However, there were some problems. "Twelve percent of the patients came back for additional therapy," he notes. "A handful of them came back a third or fourth time. We basically cut them off after four episodes."

The investigators tried to identify the source of HIV exposures in the PEP patients. While 31% of PEP recipients who knew that their source contact was HIV positive recruited that person for program participation, only 12% of those who did not know their contact's HIV status recruited that contact. But she says that the experience gained during the study will help improve this record. "I think we've learned some important lessons that maybe we can use to help [people bring in] their source contacts," she says.

Session moderator Mitchell Katz, MD, San Francisco Department of Public Health, also participated in the study. He admits that despite its successes, the PEP program reached only a fraction of eligible patients.

"The numbers in both these studies represent a very small proportion of people coming forward," Katz says. "There are an estimated 500 new sexually transmitted HIV infections in San Francisco every year. Since you have a tiny risk per exposure, then there is a lot of high-risk behavior going on to get 500 infections per year."

Roland worries that physicians may decide to give patients a shorter course of PEP rather than the 28-day course validated by the study. "I'm worried that people are recommending a 7-day course of treatment," she says. "My concern is you decide to do something and you don't change until you have tested it against the current gold standard. So my statement is, either you want to take the med[ications] or you don't. It may be too much medicine, but right now it is the best thing we have."

 

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