Recently, the Public Health Service has recommended the use of antiretroviral drugs to reduce (1) perinatal HIV transmission and (2) HIV acquisition among persons exposed in the workplace (e.g., accidental needle-sticks received by health care workers). These recommendations were based on the results of scientific studies that demonstrated the effectiveness of this therapy for reducing HIV infection in these populations. Recently, public discussion has arisen about whether similar treatments should be offered to people with unanticipated sexual or drug injection-related exposures to HIV. However, no studies have been done with these types of exposures, leaving more questions than answers.
One thing we know for certain is that the most effective, most widely available, and least costly, methods for the prevention of HIV infection continue to be those that prevent exposures to HIV.
Attempting to prevent HIV infection by taking antiretroviral drugs should not take the place of adopting and maintaining behaviors that prevent HIV exposure. These include sexual abstinence, consistent condom use, abstinence from injection drug use, and consistent use of clean equipment for people who are unable to cease injection drug use. Post-exposure prophylaxis with antiretroviral medication should always be the exception rather than the rule.
We also know that any potential antiretroviral treatment for these exposures would not be effective as a single "morning after" pill. The therapy would require multiple drugs which would have to be taken every day -- several times a day -- for at least 30 days. Further, there are significant costs and health risks in conjunction with this therapy. A 30-day course of these medications will cost $600-$1,000, which in many cases will not be covered by insurance. In addition, these drugs have severe side effects, some of which can be life-threatening. Also, if a person became infected despite taking antiretroviral medication, there is a significant risk that their infection would be difficult to treat because of its resistance to antiretroviral medications.
Although the situations in which the benefits of post-exposure prophylaxis outweigh the risks are likely to be uncommon, if such therapy is proven effective, it should be available for certain situations. These and other issues must be considered carefully before any recommendations can be made about if and when to use this therapy. The Centers for Disease Control and Prevention (CDC) and its prevention partners have invited a wide variety of consultants to meet in late July to evaluate the available information and determine whether appropriate recommendations can be made at this time.
Division of HIV/AIDS Prevention National Center for HIV, STD, and TB Prevention Centers for Disease Control and Prevention Atlanta, GA June 10, 1997