AIDSWEEKLY Plus; Monday, July 27 & August 3, 1998
Daniel J. DeNoon, Senior Editor
A U.S. Centers for Disease Control and Prevention (CDC) study shows that most health-care workers accidentally exposed to HIV don't finish taking recommended drugs to prevent infection.
"Providing more information up front regarding what side effects to anticipate and how to treat the symptoms, we may be able to improve compliance," said CDC researcher Adelisa Panlilo. "But the difficulties with compliance highlight the need for improved efforts to prevent HIV exposure."
Panlilo reported the study findings in a presentation to the 12th World AIDS Conference, held June 28-July 3, 1998, in Geneva, Switzerland.
A previous study of health-care workers who received post-exposure prophylaxis (PEP) with antiretroviral drugs found an 81 percent reduction in HIV infections. Based on these findings, U.S. Public Health Service guidelines have since June 1996 advised a four-week course of potent antiretroviral drugs for all health-care workers with significant occupational exposures to HIV.
Panlilo and colleagues collected data on 188 health-care workers who reported occupational HIV exposure. Of the 114 individuals for whom one follow-up was available, 58 took PEP: 28 percent took zidovudine (AZT) alone (in all cases before combination therapy with protease inhibitors became available); 34 percent took AZT and one other antiretroviral; 34 percent took AZT and two other drugs; and 4 percent took a four-drug combination.
Only 19 of the 58 PEP recipients finished their prescribed course of treatment, and four modified their regimens. Of the 21 who stopped PEP and for whom information was available, three-fourths said they did so because of drug-related symptoms.
"As a society, we tend to focus more on testing, rather than preventing disease - yet this study demonstrates that medical solutions aren't always the easy answer we're looking for," said Helene Gayle, director of the CDC's National Center for HIV, STD, and TB prevention. "While PEP can reduce the chances of infection for exposed health-care workers, these drugs can cause adverse side effects and are not 100 percent effective. The most effective way to protect health-care workers is to prevent exposure in the first place."
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