People who do not have HIV but seek antiretroviral medications following high-risk sexual encounters are very likely to complete the full monthlong drug regimen, according to a new UCLA AIDS Institute study. Moreover, there is a strong demand for publicly available post-exposure prophylaxis among high-risk populations in Los Angeles County.
Based on these findings, the researchers recommend that Los Angeles County make post-exposure HIV prophylaxis available to citizens who have engaged in high-risk sex, just as it has for health care workers who inadvertently find themselves at risk due to accidental needle sticks. The study is available on the Web site of the journal AIDS Care for free to nonsubscribers through Dec. 31.
"We frame this as a social justice issue. People with means and health insurance plans do get post-exposure prophylaxis because they can pay for it," said Steven Shoptaw, professor of family medicine and psychiatry at the David Geffen School of Medicine at UCLA and a member of the UCLA AIDS Institute. "It is our belief that we have a responsibility to provide that level of protection to all our citizens. These data show that when this kind of prevention is made available, the at-risk community will access and use it."
Researchers based their conclusions on a study that followed 100 people who received HIV medications following unprotected, very high-risk sex. Each participant was given 28 days worth of lamivudine and zidovudine, as well as HIV tests and physical examinations, and was scheduled for a follow-up visit 26 weeks later. Participants were highly educated in general, 63 percent were gay and 95 percent were male.
Of the participants, 75 percent completed the monthlong drug treatment and none were found to have converted to HIV-positive status, the researchers said. Given that such a high percentage of patients completed the full drug regimen, UCLA researchers concluded that it would be feasible to develop a post-exposure prophylaxis plan for at-risk populations that could be implemented through Los Angeles County.
"We have 2,000-plus HIV infections in this county every year, and that rate has been stable for a number of years, which signifies that behavioral prevention has reached its peak," Shoptaw said. "Having post-exposure prophylaxis available may provide another arrow in the quiver to prevent new HIV infections."
To view the full text of study in the journal AIDS Care, visit www.informaworld.com/smpp/content?content=10.1080/09540120701660353.
In addition to Shoptaw, study authors were Erin Rotheram-Fuller, Jason Wang, Ardis Moe, Raphael J. Landovitz and Cathy Reback of UCLA, and David E. Kanouse of the RAND Corp. Shoptaw is also affiliated with the Baltimore-based Friends Research Institute, and Reback is associated with the Van Ness Recovery House Prevention Division in Los Angeles.
The National Institute on Drug Abuse, the City of Los Angeles AIDS Coordinator's Office, the Friends Research Institute and GlaxoSmithKline supported the research through grants, recruitment and provision of medications.
Established in 1992, the UCLA AIDS Institute is a multidisciplinary think tank drawing on the skills of top-flight researchers in the worldwide fight against HIV and AIDS, the first cases of which were reported in 1981 by UCLA physicians. Institute members include researchers in virology and immunology, genetics, cancer, neurology, ophthalmology, epidemiology, social science, public health, nursing, and disease prevention. Their findings have led to advances in treating HIV, as well as other diseases, such as hepatitis B and C, influenza, and cancer.
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