Supplemental HIV prevention

A 28-day course of anti-HIV cocktail might prevent infection after an isolated exposure.

On Thursday, the Centers for Disease Control and Prevention in Atlanta announced a new, more liberal policy regarding emergency HIV prevention. The centers now recommend that rape victims and those engaged in isolated incidents of unsafe sex or intravenous drug use be treated with a 28-day course of a three-drug, anti-HIV cocktail.

A few states and individual cities, such as San Francisco, had already developed postexposure emergency protocols for at-risk people. Many countries in Europe, as well as Australia and Brazil, also have such recommendations and policies in place.

These recommendations are long overdue in this country, most likely because many lawmakers seem to shy away from any talk of risk attributed to sexual promiscuity. While many HIV victims contracted the disease while engaging in unsafe sex and sharing drug needles, others became infected through no fault of their own – and it is time they are given the treatment options available to them.

The centers acknowledge, of course, that emergency antiretroviral drugs are no substitute for surefire alternatives, such as abstinence and monogamy with an uninfected partner, or precautions, such as condoms and sterile needles. It also places some of the burden on each attending doctor to weigh the risks and benefits of the treatment when exposure status is unknown.

Therefore, those who regularly engage in unsafe sex or intravenous drug use should not consider this recommendation a license to continue their risky behaviors. The cocktail as a prophylactic is not proven to work in humans. In primates, it prevented infection of their form of the virus 100 percent of the time only when given within 24 hours of exposure and approximately half the time when given 72 hours after exposure. This model strongly suggests a similar effect in humans, but is not a guarantee.

Hopefully, these new guidelines will prevent needless infections of HIV. However, the treatment should not remove the focus from preventing the reasons for many infections: unsafe sex and drug use. Programs directed toward prevention education in this country and abroad should certainly not be abandoned.