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'Morning After' Approach Advised to Prevent HIV

CDC Recommends HIV Drugs Within 72 Hours of Exposure to Virus

WebMD Health News

Jan. 21, 2005 -- Anyone exposed to HIV as a result of rape, occasional drug use, or unsafe sex should be treated with HIV drugs, says the CDC.

The move marks a major shift in CDC policy, which previously recommended use of HIV drug cocktails - known as antiretroviral drugs -- only to health care workers who were exposed to HIV through accidental needle injuries or other contact with HIV-infected blood.

The new recommendations expand the use of this approach to rape victims and others who seek treatment within 72 hours of exposure to the virus through sexual intercourse, sexual assault, or sharing a needle with a person known to be HIV-infected.

"Using antiretroviral drugs after exposure is an important safety net to prevent HIV infection in certain cases," says Ronald O. Valdiserri, MD, MPH, deputy director of the CDC's National Center for HIV, STD, and TB Prevention, in a news release. "But the drugs are not a substitute for abstinence, mutual monogamy, or consistent and correct condom use, and should not be viewed as a quick fix."

An estimated 40,000 new HIV infections occur each year in the U.S. Researchers say the most effective means to prevent HIV infection is to prevent exposure to the virus, but the use of antiretroviral drugs after exposure can drastically reduce the risk of infection.

HIV Drugs for All

The new guidelines update guidance from the U.S. Department of Health and Human Services issued in 1998. At that time, researchers say there was not enough evidence to recommend for or against this approach.

Since that time, new studies have shown that use of HIV drugs has reduced the risk of infection by 80% among health care workers. In addition, giving these drugs to HIV-infected pregnant women has also been shown to reduce the risk of mother-to-child transmission by about 50%.

The treatment involves taking a combination of three HIV drugs daily for 28 days. There is a limited window of opportunity in which to prevent permanent infection. Treatment must be started within 72 hours after exposure.

The drugs work by inhibiting replication of the virus and preventing it from spreading into the bloodstream and throughout the body. The sooner treatment is started, the better the chances that it will prevent HIV transmission.

If a person seeks treatment more than 72 hours after exposure, drug treatment to prevent HIV is not recommended.

If someone has sex with a person and doesn't know the partner's HIV status, the CDC recommends that doctors and patients weigh the potential benefits of treatment against any risks of the drugs. The same applies for someone that uses a drug needle from someone whose HIV status is unknown.

CDC officials say this approach may also not be appropriate for people who are frequently at risk for HIV exposure, such as those who have sex with HIV-infected partners and rarely use condoms and injection drug users who often share equipment. Instead, these people would benefit from more intensive risk-reduction strategies rather than attempting to reduce their risk of HIV infection after exposure.

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