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Policy & Politics

CDC Recommends Prophylactic Antiretroviral Drug Regimen for People Exposed to HIV Through Unprotected Sex, Shared Needles

January 21, 2005

CDC on Thursday in a "major policy shift" recommended that people exposed to HIV through unprotected sexual intercourse, sexual assault, shared needles or accidents receive immediate treatment with antiretroviral drugs to prevent infection, the AP/Chicago Tribune reports (Yee, AP/Chicago Tribune, 1/21). The move expands 1996 CDC guidelines that recommended post-exposure prophylaxis only for health care workers exposed to HIV through occupational accidents, USA Today reports (Manning, USA Today, 1/21). CDC said the new guidelines -- which were published on Friday in CDC's Morbidity and Mortality Weekly Report -- are based on studies showing that beginning an antiretroviral regimen shortly after exposure can reduce the risk of HIV infection by as much as 80% (Goldstein, Miami Herald, 1/21). CDC said that to be effective, prophylactic antiretroviral regimens must be started no later than 72 hours after HIV exposure and continue for 28 days (McKay, Wall Street Journal, 1/21). CDC recommends that individuals take efavirenz and lamivudine or emtricitabine with zidovudine or tenofovir and lopinavir/ritonavir and zidovudine with either lamivudine or emtricitabine, but says that "[d]ifferent alternative regimens are possible" (Reuters, 1/20). In its guidelines, CDC warned that prophylactic treatment is "not a substitute for abstinence, mutual monogamy, consistent and correct condom use, use of sterile needles and syringes to inject drugs and other behaviors that can help avoid HIV exposure in the first place," according to a CDC release (CDC release, 1/20). Some states -- including Massachusetts, New York and Rhode Island -- already have policies for treating sexual assault survivors with antiretrovirals. Some cities, including San Francisco, also have developed policies to treat others who have been exposed to HIV, including men who have sex with men, commercial sex workers and injection drug users, according to the AP/Las Vegas Sun.

Some health professionals "applauded" CDC's new guidelines, the AP/ Sun reports. "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," Dr. Josh Bamberger of the San Francisco Department of Public Health, who helped create that city's policy on prophylactic HIV treatment, said, adding, "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. That's amazing" (Leff, AP/Las Vegas Sun, 1/21). However, some physicians who treat HIV-positive patients said that the new guidelines give a "false sense of security," according to the Herald. "I think this will give the wrong message to the public -- that it's OK to have unprotected sexual relations because there are medicines available," Dr. Corklin Steinhart, who treats more than 2,000 HIV-positive patients, said (Miami Herald, 1/21). Other doctors said that the old guidelines were "unconscionable" and put the United States "years behind" other countries, according to the AP/Sun. "While prudish political appointees delayed the CDC release by four years, thousands of unnecessary HIV infections may have occurred," California state Assembly member Paul Koretz (D) -- who sponsored a bill two years ago calling on state health officials to make antiretrovirals available to people exposed to the virus outside of the workplace -- said, adding, "The fact that politicians are uncomfortable talking about sexual exposures to HIV is no reason to withhold vital information from doctors" (AP/Las Vegas Sun, 1/21).

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