Believe in Miracles?

For people living with HIV, antiretroviral medications have been shown to be effective in preventing progression to AIDS and in improving their quality of life. But these same meds used to treat HIV infection have another benefit; they can be given to an HIV-negative individual who has been exposed to HIV, either through a high-risk sexual or needle-sharing exposure. This type of treatment is called nonoccupational postexposure prophylaxis, or nPEP. For example, if an HIV-positive person has sex with someone who is negative and a condom breaks, the person exposed should be offered antiretrovirals. In fact, giving someone nPEP can reduce the partner's chances of becoming HIV infected by up to 80%! There are two key points that people need to know about nPEP. For one, the quicker that one starts the therapy after the exposure, the more likely nPEP is going to work. The Centers for Disease Control and Prevention says that nPEP is still likely to work for up to 72 hours after the exposure occurred. But one should not wait that long to make the decision or to tell his or her partners to seek care. Every hour that goes by increases one's chances of becoming infected. The other key point that is important to remember is that nPEP needs to be taken for 28 days. Many people who start nPEP do not complete the full 28-day course and thus are less likely to prevent HIV infection. The choice of which meds to give depends on several factors. In New York, for example, we typically give Combivir and Viread. However, if the HIV-positive person that exposed the person has a drug-resistant virus, we typically change the regimen to something that the HIV-positive person's virus is sensitive to. Sometimes that can mean giving someone a lot of meds, including a protease inhibitor or some of the newer drugs used to treat HIV. Oddly, people who are HIV-negative seem to not tolerate these meds as well as people that are HIV-positive, and for that reason it is important to follow patients during their month-long therapy. Although nPEP has been available for almost a decade, very few people know about it or have ready access to the meds. One reason for this is that many doctors and hospitals have been slow to pick this up and are concerned that offering nPEP to people will increase unsafe sex and drug use. Also, many patients feel embarrassed or awkward about asking their providers about nPEP. But every person has a right to the treatment. And nPEP should also be discussed with every HIV-positive patient as a prevention tool in the event of a high risk exposure with someone who is negative or whose serostatus is unknown. Urbina is an HIV specialist and the medical director of HIV education and training at St. Vincent's Comprehensive HIV Center as well as an associate professor of medicine and an associate professor of clinical public health at New York Medical College.