Petrelis Files

SF HIV PEP Study:

Infections Averted With Cocktails

One of the best, and largely unused and unpromoted, tools in the HIV prevention arsenal are the potent drug cocktails. These life-extending medicines not only give hope to people infected with HIV/AIDS, but when properly employed can serve in numerous ways to stop new infections.

First, as eminent Swiss researchers reported last year, when poz people on the cocktails are on them for at least six months, and reduce their viral loads to undetectable levels, and don't have any STDs, the pozzies are non-infectious. Get people with HIV on the meds and their infectivity drops to practically nil.

Second, the cocktails are also "morning after" pills, that when started within 72 hours after risky sex, and continued for 30 days, can prevent contraction of HIV infection. This course of action is known as PEP, post-exposure prophylaxis, and has been heavily promoted among health care workers and nurses at elevated risk of exposure from needle pricks.

The third option is to give folks engaging in high risk sexual activity and not adhering to the condom code PREP, pre-exposure prophylaxis, and is still being investigated by federal researchers.

Option number two, PEP, received a much-welcomed boost right before Christmas when the SF health department issued the November monthly STD report and experts released good news about the provision of cocktails to hundreds of high-risk gay men over a six-year period.

I spoke with a source at DPH who told me with limited resources for follow up among a small to medium number of patients, that no new infections occurred in the population that received PEP once. There were a few infections in the population that took PEP several times.

Unfortunately, DPH provides no follow up data in the editorial note, but officials are pleased with the PEP program, which will continue to serve at-risk individuals who slip up in their safe sex practices.

As you read the numbers and findings, bear in mind that there is no formal active campaign from either the DPH or AIDS Inc or UCSF's many HIV programs telling sexually active gay men about PEP. Pretty amazing that without a major educational push for PEP, almost 1,000 people received PEP in San Francisco.

Imagine how many new infections could be averted if AIDS Inc got around to embracing and puiblicizing PEP, the Swiss recommendations and PREP!

Click here for the full DPH report:

San Francisco Monthly STD Report
Data for November, 2008
Report prepared December 18, 2008

Editorial Note: Non-occupational HIV post-exposure prophylaxis (NPEP) at San Francisco City Clinic

City Clinic is the primary public provider of non-occupational HIV post-exposure prophylaxis (nPEP) in San Francisco. Eligibility for nPEP is determined by a clinician and based on the HIV-transmission risk of the patient's reported exposure.

From 2002-2007, 971 patients received nPEP at 1,103 visits. While 835 patients (86%) were prescribed nPEP once during this period, 124 (13%) received it up to three times, and 12 (1%) received four or more courses.

Of all patients receiving nPEP, 85% were men who have sex with men, 8% were women, 5% were heterosexual men, and 2% were transgender.

The median age was 33 and a sizeable minority (36%) was non-white.

In 2007, 86% more courses of nPEP were prescribed than in 2002, and recipients were more likely to have requested nPEP when they presented at the clinic in 2007 than in 2002 (p<0.0001).>

[UPDATE]

A friend writes in with some concerns, that I should have addressed:

Great post about an important prevention strategy that remains largely unknown.

However, I do have two quibbles. You note that PEP started within 72 hours makes someone "non-infectious". I always try to say "virtually non-infectious" or something similar, so people don't see it in absolute terms because, of course, there is still a small chance of infection.

The other point is to let people know that the closer to the point of exposure one starts PEP, the better chance it has of working. Efficacy at 72 hours is probably less than it is within 24 hours. That's why I advise people who are negative to keep a short-course of anti-retrovirals on hand so they can start immediately if they have a slip, pending further consultation and reflection on whether or not they need to go on the full 30 day protocol.