Rhode Island: HIV Treatment Guidelines Published

Rhode Island has become the first state to publish treatment guidelines for people exposed to HIV outside the health care setting. The guidelines specify drug regimens that can prevent infection if administered within 72 hours of exposure. They are intended for people who were exposed to HIV through rape, sex, injecting drug use and other contact with HIV-infected fluids.

"If someone has been exposed to HIV, it's not an automatic infection," said Dr. Roland Merchant, an emergency physician at Rhode Island Hospital who helped write the guidelines. "There appears to be a window of time of maybe 72 hours. ... If you get the drugs prior to the infection taking hold, you might be able to contain the virus and get rid of it."

In 1996, the CDC issued guidelines for health care workers who are exposed to HIV by coming in contact with an infected person's blood or accidentally pricking themselves with a used needle. But, said Merchant, "There's only been about 150 suspected cases of people who have gotten infected with HIV who are health care workers, compared to almost a million who are not health care workers."

Doctors who encounter a patient who may have been exposed to HIV can use the guidelines to weigh the risks and choose an appropriate drug cocktail. The drugs are costly and have side effects, so those negatives have to be weighed against the likelihood that the patient was exposed to HIV. A two-drug regimen for a month may be adequate for most situations, Merchant said. However, if the person with whom the patient had contact is known to have HIV, then a three-drug regimen might be more appropriate. Merchant cautioned that the therapy should not be regarded as protective: Prevention still works best, and people should not take the drugs and then feel safe from irresponsible behavior.

The entire 30-page document can be found on the Health Department Web site www.healthri.org.

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