HIV Preventive Treatment Does Not Up Risky Sex

In a recent study of 200 gay men, Dr. Mauro Schechter of Universidado Federal de Rio de Janeiro, and colleagues, examined the acceptability, safety, and impact on sexual behavior of postexposure chemoprophylaxis (PEP) for HIV following sexual exposure.

Of the subjects, 68 took PEP -- consisting of lamivudine and zidovudine in a fixed-dose combination tablet -- after high-risk activity. Eighty-six of the men did not take PEP, despite at least one high-risk exposure during the study. Forty-six subjects denied engaging in high-risk behavior during the study.

The results showed that the average number of partners for subjects who took PEP and those who did not was the same six months before the study and in the six months before the final study visit. For both groups, on average, high-risk behaviors declined over time. During the study period, 11 subjects became infected with HIV -- about the number expected given the group's risk profile.

Schechter explained to Reuters Health that the study was originally designed in 1997 as a pilot study to examine behavior changes in preparation for a larger study of efficacy. "Since that time, things have changed and I believe it would be unethical to conduct an efficacy trial now," he said. "I believe PEP will become one more thing we do in medicine because we believe it works, although formal proof is lacking and will likely never be available."

"PEP is safe... and most people don't start practicing unsafe sex just because PEP is available," Schechter said, though he added that PEP is not likely to have a major impact on the epidemic, "and thus has to be viewed as just one more tool to prevent infection."

The full report, "Behavioral Impact, Acceptability, and HIV Incidence Among Homosexual Men with Access to Postexposure Chemoprophylaxis for HIV," was published in the Journal of Acquired Immune Deficiency Syndromes (2004;35(5):519-525).

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