Sept. 21, 2000 (Toronto) -- Rape victims want immediate access to drugs that might protect them from HIV infection. And a program that provides them with the drugs for free is a success, French researchers report at a medical conference here.
AIDS drugs given to a person soon after unsafe sex or exposure to potentially infected blood is called post-exposure prophylaxis, or PEP. Although PEP is given routinely to health care workers who suffer needlestick accidents, the risk of infection after a single exposure is so low that nobody can say for sure whether PEP really works to prevent HIV infection.
While U.S. health care officials debate the merits of post-exposure prophylaxis programs, physicians in France routinely provide the service. Because AIDS drugs have serious side effects, there has been a question of whether the risk of HIV is high enough to aggressively provide PEP to rape victims. A study of 100 rape victims in the Ile de France region now shows that people who have been raped are very eager to obtain the treatment.
"In France, there is always a strong request for PEP from victims of rape," forensic medicine specialist Jean-Pierre Benais, MD, tells WebMD. "All victims are offered the drugs immediately -- at no charge."
French law allows men accused of rape to refuse HIV testing. Few of the accused aggressors in the study agreed to the test, but three admitted to being infected with the AIDS virus.
The study found that 90% of the rape victims accepted PEP, although only 48% of them completed the one-month, three-drug regimen. Ten victims stopped treatment when HIV tests of their alleged rapists came back negative; four stopped because of the drugs' side effects. These side effects were very common and included diarrhea (seen in 78 of the patients), nausea (seen in 54 patients), pain (38 patients), and vomiting (seven patients). After the first 15 days of treatment, these symptoms usually went away.
None of the study patients developed an HIV infection, despite this relatively poor compliance with treatment. Paris Health Dispensary physician Jean Derouineau, MD, tells WebMD that a better compliance rate -- about 80% -- is usually seen in patients who get post-exposure prophylaxis after an unsafe sexual exposure.
The French PEP program requires that patients be seen on a weekly basis. Even though drugs are given for only one month, the weekly visits continue for six months -- visits that are especially important for rape victims, who experience serious psychological distress.
"When you follow a person for six months, you can talk with them about drug side effects and sexuality and feelings," Derouineau says. "I think drugs are just one part of the treatment."
One reason U.S. government officials have been reluctant to initiate PEP programs is the fear that people will abandon safe-sex practices and instead rely on AIDS drugs for protection.
"We never have seen people stopping safe sex and relying on PEP," Derouineau says. "We can say for sure that nobody abuses this treatment."
But one U.S. expert says much more study is needed before PEP can be made standard care for rape victims here.
Health care experts need not only to determine whether PEP really can head off HIV infections, but to weigh the risk individual rape victims face, says Jefferey Lennox, MD, an assistant professor of medicine in infectious disease at Emory University and medical director of the Grady Health System Infectious Disease Program, both in Atlanta.
He explains that the need for PEP will differ from country to country and even from region to region within countries. The percentage of people who are HIV-positive in any one area differs around the world, he says, and, therefore, so does the risk that a rape victim will contract the virus.
"It's a very complicated issue," Lennox says.