HIV/AIDS Prevention

In June of 1996, CDC's Morbidity and Mortality Weekly Report published "Update: Provisional Public Health Service Recommendations for Chemoprophylaxis After Occupational Exposure to HIV," which recommended the use of anti-retroviral agents as postexposure prophylaxis (PEP) for certain occupational exposures to HIV. These recommendations were developed by an interagency working group made up of representatives of CDC, the Food and Drug Administration, the Health Resources and Services Administration, and the National Institutes of Health. This group consulted with outside experts who participated in a workshop on this subject convened by CDC and the National Foundation for Infectious Diseases in March of the same year.

However, not enough currently is known about the safety of using these drugs in people not infected with HIV. To learn more about their safety and how well they are tolerated, CDC and two drug companies, Glaxo Wellcome, Inc., and Merck & Co., Inc., have established the HIV Postexposure Prophylaxis Registry. This is an important new prospective surveillance system designed to collect information about the experiences of health-care workers (HCWs) who receive PEP. All health-care providers who prescribe PEP are encouraged to participate.

HCWs who are exposed to HIV are advised by their health-care provider about the risks and benefits of taking these drugs. Those who choose to take the drugs are asked to participate in the study; participation is voluntary and confidential. Information is obtained at the beginning of treatment, after completion of treatment, and 6 months after the exposure. Information collected includes the type of exposure, what kind of drugs the HCW is taking to prevent HIV infection, how long the drugs are to be taken, any side effects experienced by the HCW, and results of HIV-antibody and other laboratory testing.

The registry has been enrolling HCWs since October 1996. The registry data are expected to provide valuable information that will help shape future recommendations for managing HIV exposure. The data also may help HCWs themselves in deciding whether to take antiretroviral drugs following HIV exposure.

If you would like additional information about this study, you may call the HIV PEP Registry toll free at 888-PEP-4HIV (737-4448) or contact Dr. Susan Wang at CDC by telephone at 404-639-6425 or by E-mail at sjw8@cdc.gov.

Visit CDC's New Hospital Infections Program on the World Wide Web CDC's Hospital Infections Program (HIP) invites you to visit its Internet home page at http://www.cdc.gov/ncidod/hip/hip.htm. The site provides information related to infection control in health-care settings, including antimicrobial resistance, blood-borne pathogens, child care health and safety, nosocomial infection guidelines and recommendations, occupational health, outbreak management, sterilization and disinfection, and surveillance.

More Questions than Answers About Other Uses of Postexposure Treatment

The most effective methods for HIV prevention remain those that prevent exposure to HIV in the first place. Attempting to prevent HIV infection by taking antiretroviral therapy should not take the place of adopting and maintaining behaviors that prevent HIV exposure. These include sexual abstinence, having sex only with an uninfected partner, consistent condom use, abstinence from injection drug use, and consistent use of sterile equipment for those who are unable to cease injection drug use.

In recent years, the Public Health Service has recommended the use of antiretroviral drugs to reduce the risk of HIV infection through perinatal HIV transmission and among those exposed in the workplace (for example, accidental needle-sticks received by health-care workers). These recommendations were based on the results of scientific studies that demonstrated the effectiveness of antiretroviral therapy for reducing HIV infection in these populations.

Questions have arisen about whether similar therapy should be offered to people with unanticipated sexual or drug injection-related exposures to HIV. However, no data currently exist about the effectiveness of postexposure therapy for these types of exposures. At this point, there are more questions than answers.

Clearly, any potential antiretroviral therapy for these exposures would not be a single pill. The therapy would require several drugs that would have to be taken every day -- several times a day -- for at least 30 days.

Potential benefits also would have to be weighed against the significant costs and health risks associated with this therapy. A 30-day course of these medications costs from $600 to $1,000, which in many cases would not be covered by insurance. In addition, these medications can have severe side effects.

Further, the therapy would not be 100 percent effective. If a person becomes infected with HIV despite taking antiretroviral medications, there is a risk that their viral strain will be difficult to treat because it is resistant to antiretroviral medications.

These and other issues must be considered carefully before recommendations can be made regarding other uses of this therapy. The CDC and its prevention partners have invited a wide variety of consultants to meet in late July to evaluate the available information and determine whether appropriate recommendations can be made at that time.

For further information, contact CDC's Dr. Dawn Smith by telephone at 404-639-6146 or by E-mail at dks0@cdc.gov.

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