Health workers support new HIV guidelines
SAN FRANCISCO, California (AP) -- Health professionals applauded the government's new recommendation that rape victims and occasional intravenous drug users get emergency drug treatment to prevent the AIDS virus, describing it as "progressive" and "a safety net."
The seismic shift in policy, announced Thursday by the Centers for Disease Control and Prevention in Atlanta, says a preventative regimen of drugs should be given to anyone exposed to HIV from rapes, accidents or isolated episodes of drug use or unsafe sex. The previous recommendation, made in 1996, had been only for health care workers accidentally exposed on the job.
"We have probably the most conservative administration in the last 50 years, and yet the CDC is coming out with a policy that is more progressive than perhaps any country's in the world," said Dr. Josh Bamberger of the San Francisco public health department, who helped craft the city's prophylactic HIV treatment plan.
"If you had unsafe sex while you were drunk or had a condom break, you should take these medicines -- that is what is recommended by the public health service of the United States," Bamberger said. "That's amazing."
Some doctors had called the previous recommendation unconscionable and said it put the United States years behind many other nations. Much of Europe, Australia and Brazil have long had guidelines calling for rape victims to receive emergency drug treatment to prevent the AIDS virus.
States such as Massachusetts, New York and Rhode Island came up with their own policies for treating rape victims at risk of contracting HIV, while some cities, including San Francisco, developed "post-exposure" protocols for treating gay men, prostitutes and intravenous drug users.
"While prudish political appointees delayed the CDC release by four years, thousands of unnecessary HIV infections may have occurred," said California Assemblyman Paul Koretz, who sponsored a bill two years ago calling on state health officials to make AIDS drugs available to people exposed though non-work activities. "The fact that politicians are uncomfortable talking about sexual exposures to HIV is no reason to withhold vital information from doctors."
People accidentally or incidentally exposed to the AIDS virus are usually given a three-drug combination that includes AZT and 3TC. Treatment should start no more than 72 hours after the exposure to the virus, and the drugs should be used for 28 days, according to the CDC.
The CDC said it hesitated to recommend wider use of AIDS drugs for curbing the spread of HIV because it did not have enough information on their effectiveness in reducing infection rates. But the agency said recent animal and lab studies and data from state and city programs that offer HIV drugs to rape victims and others provided a foundation for revising the guidelines.
"The severity of the HIV epidemic dictates we use all available tools to reduce infection," said Dr. Ronald Valdiserri of the CDC.
He stressed that emergency drug treatment is a "safety net," not a substitute for abstinence, monogamy, and the use of condoms and sterile needles.
"It is clearly not a 'morning-after pill,"' he said.
In tests on primates, drug cocktails prevented infection with the monkey version of HIV 100 percent of the time if given within 24 hours of exposure to the virus, and 52 percent of the time if administered within 72 hours, said Dr. Charles Gonzalez, assistant professor of medicine at New York University School of Medicine and a member of the New York State AIDS Institute medical guidelines board.
But no data exists on how effective the drugs are in stemming HIV infection in people.
The new guidelines do not bind the U.S. government to pay for the treatment regimen through Medicare or Medicaid, and no federal money has been allocated to help carry out the recommendations.
The CDC said the regimen is not recommended for habitual drug users who share needles or for people who frequently engage in risky sex. Those people would have to take medication practically nonstop, which the health agency does not endorse.