Public Health Service Guidelines for the Management of Possible Sexual, Injecting-Drug-Use, or Other Nonoccupational Exposure to HIV, Including Considerations Related to Antiretroviral Therapy

Evidence of Current Practice

Some physicians have been asked to provide antiretroviral agents after certain sexual exposures, including rape by an assailant of unknown HIV status and risk history.^(44,45) Other reported exposures that could lead to requests for antiretroviral prophylaxis include injecting-drug-use relapse;⁽⁴⁾ condom breakage during anal sex between HIV-serodiscordant partners;⁽⁴⁶⁾ nonconsensual sex in correctional institutions;⁽⁴⁷⁾ and breast-feeding of newborns by HIV-infected mothers.⁽⁴⁸⁾ Because data have not been collected systematically in the United States, it is not possible to estimate either the frequency of such requests or the actual use of antiretroviral agents in these situations, or the adherence to or effectiveness of the prescribed therapy. No summary information about what specific drug therapies are being prescribed is available, although some physicians have based their practice on published guidelines for treating occupational exposure.⁽²⁾

Outside the United States, some guidelines are in use despite the absence of effectiveness data. In Canada, the British Columbia Centre for Excellence in HIV/AIDS has published A Guideline for Accidental Exposure to HIV, which recommends antiretroviral agents for rape victims (in addition to persons with occupational HIV exposure). To allow postexposure antiretroviral therapy to be initiated quickly, the Centre provides a free "starter kit" of 5 days of therapy with ZDV and lamivudine (3TC) to emergency rooms where specialized teams care for the victims of sexual assault or to physicians upon request.