HIV Treatment After Risky Sex Debated

According to Dr. John Richens of the Center for Sexual Health and HIV Research in London and colleagues, "there is a distinct danger that the promotion of PEP [post-exposure prophylaxis] after sexual exposure to HIV could reinforce rising trends in risky sexual behavior and might add to, rather than lessen, sexual exposure to HIV." In an editorial in the journal Sexually Transmitted Infections, the authors said, "until the evidence is clearer, we would question the wisdom of a national campaign publicizing access to free provision of PEP after sexual exposure to HIV."

"I believe in a certain model of risk behavior that predicts that the benefits of PEP will be offset by unintended effects on sexual risk taking," Richens explained.

In an editorial reply, Dr. Martin Fisher of Brighton and Sussex University Hospitals noted that Richens and colleagues were concerned that "individuals will engage in high-risk activity in the knowledge that PEP after sexual exposure to HIV is available. However, contrary to these concerns, all available data suggest that this is not the case."

Two studies that examined behavior after PEP found that high-risk sexual acts declined over time. A large multicenter observational study in the United Kingdom is currently gathering data on individuals who receive PEP and "will provide some information on efficacy and tolerability," Fisher noted. "Clearly more work needs to be done on the possible effects on risk behavior, though what work has been performed to date suggests there is not a deleterious effect."

Fisher stressed that PEP "should be considered only one strand of HIV prevention -- essentially a last strand if conventional, cheaper and better proven methods have failed."

The editorial, "Can the Promotion of Post-Exposure Prophylaxis Following Sexual Exposure to HIV (PEPSE) Cause Harm?," and the editorial reply, "Can the Promotion of Post-Exposure Prophylaxis Following Sexual Exposure to HIV (PEPSE) Cause Harm?: Response," appeared in Sexually Transmitted Infections (2005;81:190-191 and 191-192, respectively).

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