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What about treating people exposed to the blood or genital secretions of an HIV-infected person?





Recently, a great deal of interest has focused on preventing transmission to uninfected persons that are inadvertently exposed by the early administration of antiviral therapy. Because the risk of infection after most isolated exposures is relatively small, generally less than 5%, formal studies are difficult to perform. Animal studies and some human experience, however, suggest that post-exposure treatment may be effective. In fact, the current recommendation is that health care workers who experience a needlestick from an infected person take antiviral medication for 4 weeks in order to reduce the risk of infection. Extending that recommendation, many physicians have proposed similar preventive treatment for people with sexual exposures to HIV. Those individuals considering this type of preventative treatment must be aware that post-exposure treatment cannot be relied upon to prevent HIV infection. Second, such treatment is not always available at the time most needed and is probably best restricted to unusual and unexpected exposures, such as a broken condom during intercourse. Third, although regimens with 2 or 3 drugs generally are recommended for those exposed in the healthcare setting, the best therapy for sexual exposure still is unknown. Fourth, therapy probably will be most effective if started within the first 2 hours after an exposure. And finally, a 4-week supply of a three-drug combination of antiviral drugs costs approximately $1000 and generally is not covered by insurance. Updated guidelines are published and available at www.hivatis.org.