CDC issues new drug guidance on HIV infection

The agency addresses sexual and needlestick exposures outside the work setting.

By Victoria Stagg Elliott, AMNews staff. Feb. 14, 2005.

A patient presenting to a physician within 72 hours of a sexual assault, condom breakage or needlestick injury that poses a high risk of contracting HIV should be prescribed 28 days of highly active anti-retroviral therapy to reduce the chance of infection, say guidelines published by the Centers for Disease Control and Prevention in the Jan. 21 Morbidity and Mortality Weekly Report.

"Using anti-retroviral drugs after exposure is an important safety net to prevent HIV infection in certain cases," said Ronald O. Valdiserri, MD, MPH, deputy director of the CDC's National Center for HIV, STD and TB Prevention.

The guidelines, developed by the CDC in conjunction with the Food and Drug Administration, the National Institutes of Health and the Health Resources and Services Administration, recommend the use of post-exposure prophylaxis -- PEP -- in cases where the source of the possible exposure is known to be HIV-positive. When the HIV status of the source is unknown, physicians should evaluate the risks and benefits, including a patient's ability to adhere to an expensive drug regimen with a high rate of side effects, on a case-by-case basis.

PEP is not recommended for people who have frequent exposures to HIV or as a replacement to more traditional forms of prevention. Rather, it is to be used as a last resort when primary prevention fails or is not possible, such as in the case of rape.

"The drugs are not a substitute for abstinence, mutual monogamy or consistent and correct condom use and should not be viewed as a quick fix," Dr. Valdiserri said.