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Sep 13, 2009

Dr. Bob,

I live in New York (the state not the city). I had a significant HIV exposure and went to an ER. The doc and staff never heard of PEP. What's up with that? Zorro

Response from Dr. Frascino


We've heard many similar stories from across the country. New York State is doing its part to remedy this unconscionable situation (see below). I'm hopeful all other states won't be far behind.

Dr. Bob

Tool to Offer Fast Help for H.I.V. Exposure

By RONI CARYN RABIN, New York Times, September 8, 2009

Time is of the essence in treating someone who may have been exposed to the AIDS virus. Starting Wednesday, emergency room doctors throughout New York State will be just a computer click away from concise guidelines for starting prompt drug treatment that can reduce the risk of becoming infected.

The guidelines come in the form of a computer application, or widget, developed by a team of doctors from St. Vincent's Hospital in Manhattan with financing from the state's AIDS Institute. They are to be given to more than 200 emergency departments this week and distributed more widely over time.

The doctors who developed the widget call it a "one-stop shopping" approach to PEP, or post-exposure prophylactic treatment. It walks users through a screening process to determine whether they are candidates for treatment, provides specific information about the 28-day course of antiretroviral drugs, and even links to consent forms in 22 languages, including Creole, Laotian and Yoruba.

The widget is continually updated with the latest medical recommendations, and the home page includes a counter that keeps track of the number of new H.I.V. infections in the state.

"There's a gap in knowledge in the health care sector about these topics," said Dr. Tony Urbina, medical director of H.I.V./AIDS education at St. Vincent's, who developed the widget with Paul Galatowitsch, also of St. Vincent's.

"You'd be surprised at how many patients come to us and say, 'I went to an emergency room, and the doctor didn't know what I was talking about, and I didn't get the drugs,' " Dr. Urbina said.

With the widget, he continued, "all of the information is right there at your fingertips, and it's also reliable and updated by the State Health Department," instead of searching for it online, on sites that might not be reliable.

The application makes clear that the first dose of antiretroviral drugs should be given as soon as possible, and patients who think they may have been exposed to the virus through sex, drug use, contact with blood or in their work should be given high-priority, emergency status.

"Here in our emergency department, when we educate our staff," Dr. Urbina said, "we say, 'Treat this as a gunshot wound in terms of urgency.' "

Post-exposure prophylactic treatment works by inhibiting the virus from multiplying and by keeping the infection localized, so the immune system can prevent it from entering the bloodstream.

Clinical trials of health care workers exposed to H.I.V. through their jobs suggest that people can reduce their risk of infection by 80 percent if they begin drug treatment immediately.

Ideally, the first dose should be given within what doctors call the "golden two-hour period" after exposure, but state health officials say the treatment is effective if started within 36 hours. (The Centers for Disease Control and Prevention puts the window at 72 hours.)

Not a question
Still freaking out after a 5 month and 6 month negative result!

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