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posted 9-15-97

San Francisco will soon become the first U.S. city to try a controversial new anti-AIDS strategy: post-HIV-exposure treatment for people who aren’t healthcare workers. While the strategy is being touted as another way to stop the spread of AIDS, many fear the false promise of a "quick fix" will undermine prevention efforts.

Starting next month,the University of California San Francisco (UCSF) and San Francisco’s Department of Public Health will administer a pilot project to provide drugs and counseling for 500 people who report being exposed to HIV in the previous 72 hours. The study is largely funded by a three-year grant from the National Institutes of Health.

At San Francisco General Hospital and two city clinics, people who believe they’ve been exposed to HIV will be interviewed about the activity that led to the exposure and the risk factors of the person believed to have transmitted HIV. Those who have had significant HIV exposure within 72 hours will be offered a combination of anti-AIDS drugs, to be taken twice daily for a month. Participants and their partners will receive AIDS-related counseling and education. The study requires follow-up visits at one month, six months, and a year. The national Centers for Disease Control and Prevention (CDC) recommends post-exposure treatment for healthcare workers exposed to HIV in work-related incidents including needlesticks. A 1994 study reported that 80 percent of healthcare workers who received post-exposure therapy did not become HIV infected. But there is no scientific research, and consequently no federal guidelines, on the treatment’s effectiveness for those whose HIV exposure occurred through nonoccupational activity, such as sexual contact or needle sharing.

Researchers would need about 7,000 patients to determine the medical effectiveness of nonoccupational post-exposure therapy, said Dr. Joshua Bamberger, MD, PhD, study coordinator at the San Francisco health department. The smaller San Francisco project is a feasibility study, examining who seeks treatment and why, and whether participants make behavioral changes.

The study has raised fears—and criticism by AIDS-advocacy groups—that post-exposure therapy could undermine prevention efforts, making people complacent about HIV treatment. "Since it is unlikely that [the treatment] is 100 percent effective, the net result could be an increase in transmission of HIV—a devastating setback," says an editorial by the San Francisco AIDS Foundation.

Even the study’s supporters acknowledge its risks and warn that post-exposure therapy should only be used as a last resort. For that reason, Bamberger said, "it’s really important that we not promote this. We’re not going to have a billboard that says, ‘Exposed to HIV? Take a pill the next day; it’s easy.’ "