Is AIDS curable immediatly after the HIV exposure?

[Guest guest]

[Moderators note: A fact sheet on What Is Post-Exposure Prevention (PEP)?

follows the posting from Ashok Nair and Subhash T.V. The need for a national PEP

policy and a PEP education program has been advocated through this FORUM]

Dear FORUM,

Is AIDS curable immediatly after the HIV exposure?

The most prevalent knowledge is that AIDS has no treatment and no Vaccine. Now

we know that AIDS is treatable but not curable which we all are trying to

spread. But the information supplied by the doctors who talk on AIDS in Kerala

is that HIV can be treated and cured if you use ARV within 2 hours of infection

which means it is only a question of time. Within 2 hours a mixture of 2

medicines can cure the disease. After that within 72 hours a mixture of 3

medicines can cure it. This treatment is given only to the doctors who get

accidental infection.

Anybody who suspects that they are infected can avail this treatment but is

being denied because the doctors think there will be a huge rush to the

hospitals. And the clamor for free treatment will be undermined. But if AIDS is

curable, don't you think it is a denial of Human Rights by suppressing this

information. Is that true? If so why this information is kept hidden from

general public.

People of western countries must be using this possibility to cure themselves

even when they suspect about their infection. Is this how the people of the rich

countries brought down their infection rate? It seems there is some truth in

this information because many statistics for western communities show increase

in STDs but not in AIDS.

Can anyone clarify these things?

FIRM

Ashok Nair and Subhash T.V

T.C.14/1514,Beatrice Mansion

Thycaud Post, Thiruvananthapuram-695 014, Kerala, India.

Tel: ++91-471-2324060, ++ 91-9447389517

E-mail: <swfk@...>

_______________________________

Fact Sheet - PEP especially after rape

What Is Post-Exposure Prevention (PEP) - especially after rape

Why PEP now?

There is still no cure for AIDS. Prevention remains the most effective way

to halt the epidemic. The best way to avoid HIV infection is to avoid expos

ure in the first place through sexual abstinence, having only uninfected sex

partners, consistent condom use, injection drug use abstinence, and

consistent use of sterile injection equipment. 1

However, recently we have learned a lot about treating HIV and understanding

the progression of HIV disease. Protease inhibitors used in combination with

other HIV drugs have been extremely effective in reducing the levels of

HIV in the blood and restoring health to many patients. 2 For HIV-uninfected

persons who are exposed to HIV, there may be a window of opportunity in the

first few hours or days after exposure in which these highly active drugs may

prevent HIV infection.

A study of health care workers showed that treatment with AZT after needles

tick exposure to HIV-infected blood reduced the odds of HIV infection by 81

%. 3,4 The study was not designed to test the efficacy of AZT for

post-exposure treatment and has some limitations. Following consultations,

the findings from this study and other data led the Centers for Disease

Control and Prevention (CDC) to recommend post-exposure prevention (more

commonly known as post-exposure treatment, post-exposure prophylaxis or

PEP) for some health care workers who are accidentally exposed to

HIV-infected body fluids.

Since PEP is recommended for health care workers, it is only logical that

PEP be considered for people exposed to HIV through sex or injection drug

use, especially since these are more common sources of HIV infection.

What are components of PEP?

There are no federal recommendations governing PEP for sexual or injection

drug use exposure although the CDC is currently studying the matter. Many

physicians and clinics across the country currently offer PEP in widely

varying forms. 5 Most forms of PEP involve providing one or several anti-HIV

drugs within 72 hours of possible exposure. These drugs are then taken for a

4-6-week period.

Before PEP is implemented, a thorough risk assessment should be conducted to

determine a patient's level and frequency of risk-taking, as well as the

HIV status of the patient's partner. Patients should be informed of the

potential side effects and difficulty taking the drugs and should be

assisted to develop strategies to successfully take the drugs as prescribed.

Partner notification and counseling can be part of a PEP program.

One of the potential advantages of PEP is the opportunity to reach and

counsel people at high risk for HIV. PEP programs should include a

behavioral counseling component to help patients develop skills for avoiding

future exposure to HIV and to deal with the fear of becoming infected.

Referrals to HIV prevention, substance abuse, medical, mental health and

housing programs should also be included to help patients address important

risk factors. 6

Unprotected sexual intercourse can result not only in HIV infection, but in

other sexually transmitted diseases (STDs) and unintended pregnancy. PEP

programs should offer testing and treatment for other STDs and testing for

pregnancy. STD infection has been shown to increase the risk of HIV

transmission 2- to 5-fold, and treating STDs is an effective HIV prevention

intervention. 7

Does PEP work?

No one knows for sure. The idea of providing potent anti-HIV drugs to

prevent infection makes sense biologically, but some people believe the

study of health care workers and AZT is not definitive, and there have been

no studies on PEP for sexual or injection exposure. The potency of the new

anti-HIV drugs, however, is a compelling, if unproven, reason to offer PEP

treatment after exposure to a life threatening disease. 8

What are disadvantages of PEP?

One of the biggest fears about PEP is that people will return to unsafe sex

ual and drug using practices if they believe that PEP will prevent them fro

m becoming infected. There is some evidence that treatment advances,

including PEP, may be leading to increasing incidence of unsafe sex in the

US. 9

For example, rates of gonorrhea among men who have sex with men have recent

ly increased for the first time since the early 1980s. 10

Another fear is that misuse of PEP drug therapies may cause a person to

develop a resistant strain of HIV. If PEP drug therapy is unsuccessful and a

person does develop a drug-resistant virus, the new anti-HIV drugs may not

be as effective for treating that person. This can occur not only with PEP,

but with any combination therapy treatment.

PEP regimens can be both complicated and prohibitively expensive to follow.

PEP drugs need to be taken at specific times of the day on a regular

schedule. About one-third of the health care workers who received PEP never

finished the regimen because of difficulty taking the drugs. 6 Side effects

of the drugs can be severe and debilitating, and long-term effects are still

unknown. A typical dosage for four weeks can cost $600-1,000 including the

medicine, blood tests and clinic visits.

Prescribing PEP can be a complicated decision for clinicians, and should be

done on an individual basis. Many believe that a person with single case of

unprotected sexual- or needle-related exposure to an HIV+ partner would be a

good candidate for PEP. However, many people worry that providing PEP

repeatedly to a person with ongoing high-risk behavior may cause

disinhibition for unsafe sex and could also be toxic.

What programs exist?

San Francisco, CA has recently implemented a project to determine the safety

and feasibility of PEP. The study offers intensive behavioral counseling,

HIV testing and anti-HIV medication to persons who have been exposed within

the last 72 hours. The project will not look at the effectiveness of PEP;

rather it will look at whether participants comply with treatments, if there

are significant side effects, and if clients change their risk behavior

following the exposure. 11

Internationally, many countries are moving ahead with PEP. In France, the

Secretary of State for Health announced in August that PEP would be made

available to all accidental exposures to HIV, whether occupational, sexual

or injection. In London, England, PEP is available through clinics and

private physicians. In British Columbia, Canada, PEP is available in

emergency rooms for patients with possible exposure.

How can PEP help?

PEP can help strengthen HIV prevention strategies by serving as a bridge

between prevention and treatment, similar to STD prevention. Traditional STD

prevention includes education, testing, early treatment, counseling, partner

notification and follow-up. In San Francisco, one PEP program is located in

an STD clinic. Many people have advocated the integration of HIV and STD

strategies. PEP is a step in that direction.

No one expects PEP to be 100% effective. No prevention tool is 100%

effective for any medical condition, whether it be HIV, unwanted pregnancy

or cancer. The best prevention effort requires a " myriad of imperfect,

cumulatively effective " 12 interventions. A comprehensive HIV prevention

strategy uses many elements to protect as many people at risk for HIV as

possible. PEP offers the opportunity to expand the range of prevention

activities, thereby expanding the possibility of saving lives.

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Says who?

1. Centers for Disease Control and Prevention. Backgrounder: CDC-sponsored

external consultants meeting on post-exposure therapy (PET) for

non-occupational exposures to HIV. Fact sheet prepared by the CDC. July

1997.

2. Deeks SG, M, Holodniy M, et al. HIV-1 protease inhibitors: a review

for clinicians. Journal of the American Medical Association. 1997;277:145

-153.

3. Centers for Disease Control and Prevention. Case-control study of HIV

seroconversion in health-care workers after percutaneous exposures to

HIV-infected blood-France, United Kingdom, and United States, January

1988-August

1994. Morbidity and Mortality Weekly Report. 1995;44:929-933.

4. Cardo DM, Culver DH, Ciesielski CA, et al. A case-control study of HIV

seroconversion in health care workers after percutaneous exposure. New

England Journal of Medicine. 1997;337:1485-1490.

5. Zuger A. `Morning after' treatment for AIDS. The New York Times. June 10,

1997.

6. Katz MH, Gerberding JL. Postexposure treatment of people exposed to the

human immunodeficiency virus through sexual contact or injection-drug use.

New England Journal of Medicine. 1997;336:1097-1100.

7. Wasserheit JN. Epidemiological synergy. Interrelationships between human

immunodeficiency virus infection and other sexually transmitted diseases.

Sexually Transmitted Diseases. 1992;19:61-77.

8. DK. Postexposure treatment of HIV-taking some risks for

safety's sake. New England Journals of Medicine. 1997;337:1542.

9. Dilley JW, Woods WJ, McFarland W. Are advances in treatment changing

views about high-risk sex? (letter). New England Journal of Medicine.

1997;337 :501-502.

10. Centers for Disease Control and Prevention. Gonorrhea among men who have

sex with men-selected sexually transmitted diseases clinics, 1993-1996.

Morbidity and Mortality Weekly Report. 1997;46:889-892.

11. Perlman D. Morning-after HIV experiment starts in SF. San Francisco

Chronicle. October 14, 1997.

12. Cates W. Contraception, unintended pregnancies, and sexually transmitted

diseases: why isn't a simple solution possible? American Journal of

Epidemiology. 1996;143:311-318.

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Prepared by Pamela DeCarlo*, J. Coates, PhD* *CAPS, UCSF

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