Can HIV exposure regimen work for outpatients?

Postexposure prophylaxis has been a means of dealing with possible HIV exposures in the hospital for years. Now interest is building for widespread use.

By Victoria Stagg Elliott, AMNews staff. May 12, 2003.

Seven years after the establishment of guidelines for HIV postexposure prophylaxis in medical settings, physicians are starting to receive some guidance for use of the regimen in the broader community.

Rhode Island became the first state to release comprehensive guidelines last September. A bill is wending its way through the California State Legislature requiring the establishment of a task force to set up the state's own guidelines. And the American Academy of Pediatrics is expected to become the first major medical society to publish its own guidelines.

"We needed to say something about it because it's an issue that is faced often by pediatricians, internists and family practitioners, and there haven't been good guidelines," said Mark Kline, MD, professor of pediatrics at Baylor College of Medicine in Houston and chair of the AAP's committee on pediatric AIDS.

Each of these efforts is an attempt to harness a method for HIV prevention when primary prevention fails. What should a doctor do when presented with a patient stuck by a discarded needle, anxious after a sexual assault, or even feeling regret after unsafe sex?

"It's a very difficult topic," said Peter L. Havens, MD, lead author on the AAP guidelines and professor of pediatrics at the Medical College of Wisconsin in Milwaukee. "In the medical setting, if a patient is in the hospital, you know a lot about them or can find out very quickly if they have HIV if you get a needlestick. In the setting of real life, if you get raped, you don't know if the guy had HIV or not and you might not be able to find [out]."