The News Service
HIV Guidelines Strong Step, But Doctors Need More To Protect Patients
The Centers for Disease Control and Prevention’s guidelines for treating patients who have been exposed to HIV through sex or injection drug use is a powerful – but partial – weapon for fighting the spread of the virus, according to a commentary in the Journal of the American Medical Association.
PROVIDENCE, R.I. — For the first time in the 24-year history of the AIDS epidemic, the Centers for Disease Control and Prevention (CDC) in January endorsed the practice of administering antiretroviral drugs to people exposed to HIV infected persons primarily through unprotected sex or injection drug use.
The guidelines are an “important initial step,” but more needs to be done to move them from paper to practice, two Brown Medical School professors assert in a commentary in the current issue of the Journal of the American Medical Association.
“Our fear is that these guidelines will sit on a shelf if there isn’t awareness about them or support to implement them,” said Roland Merchant, M.D., lead author of the article and an assistant professor in the Departments of Emergency Medicine and Community Health at Brown Medical School and an attending physician in Rhode Island Hospital’s Department of Emergency Medicine. “We see this as a first step.”
Merchant noted that nearly all new HIV infections – about 40,000 each year in the United States – occur due to “nonoccupational” exposure. Unlike health care and other workers exposed to infected blood or body fluids while performing their jobs, these individuals typically acquire the virus through sexual intercourse or injection-drug equipment.
Under the CDC guidelines, patients with a significant “nonoccupational” exposure to someone with a known HIV infection in the previous 72 hours can be treated with a three-drug combination of antiretroviral medications – a step aimed at preventing infection. Patients should take the drugs for 28 days under monitoring and be watched for signs of an acute infection, according to the CDC. Such an approach is called nonoccupational postexposure prophylaxis, or NPEP.
Merchant and co-author Kenneth Mayer, M.D., note that the guidelines don’t cover the vast majority of people at risk – those who may have had a high-risk exposure but are unclear about the HIV status of the person with whom they’ve had sex or shared needles. Virtually all sexual assault survivors, for example, are unaware of the HIV status of their assailants.
Merchant and Mayer also say that doctors will need additional resources – such as assistance with drug monitoring and access to rapid HIV testing – before they can use the guidelines effectively.
“We need to see additional steps taken to help those most at risk,” said Mayer, professor in the Departments of Medicine and Community Health at Brown Medical School, director of the Brown University AIDS Program, and attending physician at The Miriam Hospital.
Merchant and Mayer have conducted extensive NPEP research and together led a task force of Brown faculty and Rhode Island Department of Health officials who formulated guidelines for NPEP use in the state.
To read the commentary, visit jama.ama-assn.org/cgi/content/full/293/19/2407.