baseballbruce30
01-22-2005, 09:18 AM
http://www.sacbee.com/state_wire/story/12091516p-12962550c.html
CDC recommends preventive AIDS drugs for those exposed to virus
By LISA LEFF, Associated Press Writer
Last Updated 2:21 pm PST Friday, January 21, 2005
SAN FRANCISCO (AP) - Health professionals applauded the federal government for including people exposed to the HIV virus through isolated episodes of unsafe sex or drug use among those recommended for emergency treatment, calling the new policy an overdue surprise from the Bush administration.
Previously, federal health officials advised a preventative 28-day regimen of AIDS drugs only for health care workers accidentally exposed on the job. But the Centers for Disease Control and Prevention expanded its guidelines Thursday, saying rape victims, as well as some individuals who knowingly put themselves at risk, should receive the drug cocktail that can keep them from becoming infected with HIV.
"We have probably the most conservative administration in the last 50 years, and yet the CDC is coming out with a policy that is more progressive than perhaps any country's in the world," said Josh Bamberger, a San Francisco Department of Public Health physician who helped craft the city's prophylactic HIV treatment plan.
"If you had unsafe sex while you were drunk or had a condom break, you should take these medicines - that is what is recommended by the public health service of the United States. That's amazing."
The recommendations, which had been in the works since 2001, represent a major shift from a policy that some doctors had called unconscionable and that put the United States years behind many other nations. Much of Europe, Australia and Brazil have long had guidelines calling for the use of HIV drugs to prevent infection in rape victims.
Without government guidance, states like Massachusetts, New York and Rhode Island came up with their own policies for treating rape victims at risk of contracting HIV, while some cities, including San Francisco, developed "post-exposure" protocols for preventatively treating gay men, prostitutes and intravenous drug users.
"While prudish political appointees delayed the CDC release by four years, thousands of unnecessary HIV infections may have occurred," said California Assemblyman Paul Koretz, who sponsored a bill two years ago calling on state health officials to make AIDS drugs available to people exposed though non-work activities. "The fact that politicians are uncomfortable talking about sexual exposures to HIV is no reason to withhold vital information from doctors."
People accidentally or incidentally exposed to the AIDS virus are usually given a three-drug combination that includes AZT and 3TC. Treatment should start no more than 72 hours after the exposure to the virus, and the drugs should be used for 28 days, according to the CDC.
The CDC said it hesitated to recommend wider use of AIDS drugs for curbing the spread of HIV because it did not have enough information on their effectiveness in reducing infection rates. But the agency said recent animal and lab studies and data from state and city programs that offer HIV drugs to rape victims and others provided a foundation for revising the guidelines.
"The severity of the HIV epidemic dictates we use all available tools to reduce infection," said Dr. Ronald Valdiserri of the CDC.
He stressed that emergency drug treatment is a "safety net," not a substitute for abstinence, monogamy, and the use of condoms and sterile needles.
"It is clearly not a 'morning-after pill,'" he said.
In tests on primates, drug cocktails prevented infection with the monkey version of HIV 100 percent of the time if given within 24 hours of exposure to the virus, and 52 percent of the time if administered within 72 hours, said Dr. Charles Gonzalez, assistant professor of medicine at New York University School of Medicine and a member of the New York State AIDS Institute medical guidelines board.
But no data exists on how effective the drugs are in stemming HIV infection in people.
Dr. Michele Roland, assistant professor of medicine at the University of California, San Francisco, and one of the nation's leading researchers on "post-exposure prophylaxis," said San Francisco's experience offers useful lessons for other jurisdictions.
The city has had a comprehensive post-exposure program that includes outreach, counseling and treatment since 1998. Fewer than two patients a day typically seek emergency HIV treatment, and because there is such a short window for offering it, officials struggled at first to determine what the best setting was for educating the public.
"I've come to conclude there is really only a subset of the population that will be interested in PEP," Roland she said. "There are people who engage in high-risk behavior and have accepted that degree of risk for themselves, and there are those who engage in high-risk behavior or are assaulted and are interested in PEP. Some of them will know about it, but not a lot of them will."
The new guidelines do not bind the U.S. government to pay for the treatment regimen through Medicare or Medicaid, and no federal money has been allocated to help carry out the recommendations.
The CDC said the regimen is not recommended for habitual drug users who share needles or for people who frequently engage in risky sex. Those people would have to take medication practically nonstop, which the health agency does not endorse.
CDC recommends preventive AIDS drugs for those exposed to virus
By LISA LEFF, Associated Press Writer
Last Updated 2:21 pm PST Friday, January 21, 2005
SAN FRANCISCO (AP) - Health professionals applauded the federal government for including people exposed to the HIV virus through isolated episodes of unsafe sex or drug use among those recommended for emergency treatment, calling the new policy an overdue surprise from the Bush administration.
Previously, federal health officials advised a preventative 28-day regimen of AIDS drugs only for health care workers accidentally exposed on the job. But the Centers for Disease Control and Prevention expanded its guidelines Thursday, saying rape victims, as well as some individuals who knowingly put themselves at risk, should receive the drug cocktail that can keep them from becoming infected with HIV.
"We have probably the most conservative administration in the last 50 years, and yet the CDC is coming out with a policy that is more progressive than perhaps any country's in the world," said Josh Bamberger, a San Francisco Department of Public Health physician who helped craft the city's prophylactic HIV treatment plan.
"If you had unsafe sex while you were drunk or had a condom break, you should take these medicines - that is what is recommended by the public health service of the United States. That's amazing."
The recommendations, which had been in the works since 2001, represent a major shift from a policy that some doctors had called unconscionable and that put the United States years behind many other nations. Much of Europe, Australia and Brazil have long had guidelines calling for the use of HIV drugs to prevent infection in rape victims.
Without government guidance, states like Massachusetts, New York and Rhode Island came up with their own policies for treating rape victims at risk of contracting HIV, while some cities, including San Francisco, developed "post-exposure" protocols for preventatively treating gay men, prostitutes and intravenous drug users.
"While prudish political appointees delayed the CDC release by four years, thousands of unnecessary HIV infections may have occurred," said California Assemblyman Paul Koretz, who sponsored a bill two years ago calling on state health officials to make AIDS drugs available to people exposed though non-work activities. "The fact that politicians are uncomfortable talking about sexual exposures to HIV is no reason to withhold vital information from doctors."
People accidentally or incidentally exposed to the AIDS virus are usually given a three-drug combination that includes AZT and 3TC. Treatment should start no more than 72 hours after the exposure to the virus, and the drugs should be used for 28 days, according to the CDC.
The CDC said it hesitated to recommend wider use of AIDS drugs for curbing the spread of HIV because it did not have enough information on their effectiveness in reducing infection rates. But the agency said recent animal and lab studies and data from state and city programs that offer HIV drugs to rape victims and others provided a foundation for revising the guidelines.
"The severity of the HIV epidemic dictates we use all available tools to reduce infection," said Dr. Ronald Valdiserri of the CDC.
He stressed that emergency drug treatment is a "safety net," not a substitute for abstinence, monogamy, and the use of condoms and sterile needles.
"It is clearly not a 'morning-after pill,'" he said.
In tests on primates, drug cocktails prevented infection with the monkey version of HIV 100 percent of the time if given within 24 hours of exposure to the virus, and 52 percent of the time if administered within 72 hours, said Dr. Charles Gonzalez, assistant professor of medicine at New York University School of Medicine and a member of the New York State AIDS Institute medical guidelines board.
But no data exists on how effective the drugs are in stemming HIV infection in people.
Dr. Michele Roland, assistant professor of medicine at the University of California, San Francisco, and one of the nation's leading researchers on "post-exposure prophylaxis," said San Francisco's experience offers useful lessons for other jurisdictions.
The city has had a comprehensive post-exposure program that includes outreach, counseling and treatment since 1998. Fewer than two patients a day typically seek emergency HIV treatment, and because there is such a short window for offering it, officials struggled at first to determine what the best setting was for educating the public.
"I've come to conclude there is really only a subset of the population that will be interested in PEP," Roland she said. "There are people who engage in high-risk behavior and have accepted that degree of risk for themselves, and there are those who engage in high-risk behavior or are assaulted and are interested in PEP. Some of them will know about it, but not a lot of them will."
The new guidelines do not bind the U.S. government to pay for the treatment regimen through Medicare or Medicaid, and no federal money has been allocated to help carry out the recommendations.
The CDC said the regimen is not recommended for habitual drug users who share needles or for people who frequently engage in risky sex. Those people would have to take medication practically nonstop, which the health agency does not endorse.