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2005-05-25-Concerns over early HIV treatment
Immediate treatment of people who may have contracted HIV could be doing more harm than good, researchers claim.
The treatment, known as PEPSE, can reduce the chance of infection if taken within 72 hours of potential exposure.
But sexual health experts from London's Mortimer Market Centre warn knowledge treatment is available could increase risky behaviour and HIV transmission.
Writing in the journal Sexually Transmitted Infections, they call for more research into PEPSE's effects.
A 28-day course of the treatment, known as nPEP in the US, has been shown to reduce the risk of infection.
Guidelines in the UK and US say the antiretroviral treatment should be given promptly to people who think they may have become infected with the virus after potentially risky sex.
But the effectiveness, impact on changing 'risky' sexual behaviour, and the financial implications of this policy have never been properly evaluated, say the experts.
A total of 167 patients who attended the London clinic where the researchers work were given PEPSE in 2003 and 2004.
They say the projected cost of PEPSE drugs this year is set to be around ￡180,000.
The researchers warn this is being done despite a lack of evidence about the effects of the treatment, and at a time when sexual health clinics are struggling to cope with demand for services and to contain the associated rising costs.
The researchers, led by Dr John Richens, write in the journal: "We are concerned that there is pressure to make PEPSE available for homosexual men regardless of cost and without proper consideration of possible negative consequences on service delivery and HIV transmission.
"We believe that there is a distinct danger that the promotion of PEPSE could reinforce rising trends in risky sexual behaviour and might add to, rather than lessen HIV transmission."
Dr Martin Fisher, an HIV/Aids consultant at Brighton and Sussex University Hospitals NHS Trust, said it was true there was not a robust evidence base for the policy.
But he said concerns that PEPSE treatment would lead to complacency and risky sexual behaviour had not been borne out by the data which was available.
He said: "In the two studies that have examined behaviour after individuals have taken PEPSE, the opposite appears to occur.
"PEPSE may well act as a 'wake-up call' and have a beneficial effect on behaviour rather than a deleterious one."
He added that, while PEPSE could cost up to ￡1,000 per patient, it was still significantly cheaper than providing treatment for HIV infection, which costs up to ￡1m.
Dr Fisher also said PEPSE is given to healthcare workers after occupational exposure, where the absolute risk is lower than that of risky sex between gay men.
And Will Nutland, of the Terrence Higgins Trust, said: "There is no firm research foundation on which to base the argument that increasing the availability of PEPSE will lead to an increase in sexual risk taking."
He added: "Ensuring that key at-risk communities know that PEPSE is available, and that it is not a morning after pill, is an important strand in the UK's HIV prevention strategy.
"Additional funding should be made available to key sexual health centres to provide PEPSE under strict prescribing criteria".