HIV Meds Might Stop Infection After High-Risk Exposure
Source: GayHealth Staff


He was HIV positive. You didnt use a condom. Now what?

It takes twenty-eight days, but its not rehab. Its an antiviral medication
regimen that can help prevent HIV infection after a high-risk exposure, but only
if
taken within 72 hours after exposure. And most people have never heard of it.

Since 1996, the treatment, which includes two or three HIV medications, has been
available and recommended for health care providers whove been
exposed to HIV accidentally in the occupational settingfor example, accidental
needle pricks. Yet while doctors, dentists and nurses have relied on the
treatment in emergency situations, few sexually active adults have ever heard of
post-exposure prophylaxis or PEP. And until today, the Centers for Disease
Control and Prevention (CDC) have never released guidelines for non-occupational
exposures, a prevention tool that could help decrease the 40,000 annual
HIV infections in the United States.

To many, the lack of non-occupational guidelines (NPEP) has been viewed as a
huge oversight, and a failure to make every prevention tool available to
patients and their providers. As HIV rates continue to increase, especially
among African Americansprimarily heterosexual women, and gay and bisexual
menit's a no brainer that the healthcare community needs more options in
treating and warding off new HIV infections.

In occupational settings, PEP has been associated with an 80 percent reduction
in the risk of infection. Given to HIV-infected women around the time of
labor it has also been shown to cut the risk of mother-to-child transmission by
about 50 percent. NPEP contains three antiviral medications (with the exception
of nevirapine, which should not be used because of severe reactions including
liver damage), and combinations vary. If your healthcare provider can get
information about the person who exposed you--including their medication
history, symptoms and viral load--they may be better able to choose the right
medication combination for you, one that the potential virus won't be resistant
to.

Talk to your doctor if you think you might have been exposed to HIV. If the
condom broke, you had unsafe sex with someone you knew had HIV, you were
sexually assaulted or if you shared needles, talk to a healthcare provider as
soon as possible. Treatment with NPEP needs to be initiated within a 72 hour
window after high-risk exposure. Treatment should be initiated as soon as
possible after exposure, however, even within that window. The treatment lasts
28
days.

Health officials warn that NPEP isnt a replacement for HIV prevention methods,
including safe sex, clean needles and, sigh, abstinence. CDC officials also
say NPEP is a serious endeavor, requiring medication adherence, and a commitment
to avoid future high-risk behaviors. In other words, NPEP is not for
people who have frequent recurrent exposures, according to the CDC. It is
clearly not a morning after pill, Ronald O. Valdiserri, MD, MPH, deputy
director
of CDCs National Center for HIV, STD, and TB Prevention, said in a press
conference on January 20.

Using antiretroviral drugs after exposure is an important safety net to prevent
HIV in certain cases, said Valdiserri. But the drugs are not a substitute for
abstinence, mutual monogamy, consistent and correct condom use, and should not
be viewed as a quick fix.

The guidelines were developed by CDC, the Food and Drug Administration (FDA),
the Health Resources and Services Administration, and the National
Institutes of Health. Visit the Web site for the CDC to view the guidelines
(www.cdc.gov/mmwr/mmwr-_rr.html.)

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