June 10, 1997
AIDS Drugs Used on `Morning After'
ATLANTA (AP) -- After a night of sex, a woman and her AIDS-infected husband take his drugs together. Another man turns to his doctor for pills after his condom breaks during a one-night stand with an infected partner.
Some doctors are already prescribing such a morning-after treatment for people who fear they may have caught HIV after risky sex, health officials say. Now the government is mulling whether to give it the stamp of approval.
The idea is to give the drugs for a month to stop the AIDS virus cold -- if it has invaded the body. But there's no proof that it works, and some doctors fear a government endorsement will be a license for careless sex.
``This is going to be a very tricky situation to recommend this as a morning-after solution,'' said Dr. David Rimland, an infectious disease expert at the Emory University School of Medicine. ``How could you ever do a study to show it makes a difference or not?''
AIDS experts at the Centers for Disease Control and Prevention are inviting doctors, state health officials and AIDS advocates to Atlanta in July to talk about the idea, and possibly make a recommendation, said Dr. Robert Janssen, director of the CDC's HIV-AIDS prevention division.
``There may be some situations where it might be appropriate,'' Janssen said, but added such a treatment should not be used on people whose reckless behavior continually exposes them to the virus.
And, he said, the drugs are highly toxic and can cause side effects, including vomiting and diarrhea.
The talks are fueled by new CDC recommendations for health care workers exposed to HIV on the job. Last year, the CDC advised that workers who stuck themselves with needles or were splashed with blood immediately take a powerful combination of AIDS drugs.
AZT and 3TC were suggested for lower risk exposures, such as blood splashes. Those two, plus a protease inhibitor called indinavir, should be taken by workers who are accidentally stuck with HIV-tainted needles.
The CDC based that advice on a study that showed health workers in the United States, the United Kingdom and France who took AZT after they were stuck cut their risk of contracting HIV by 79 percent.
If there is a recommendation after the July meeting, the same drugs would be used: AZT and 3TC daily for four weeks. A protease inhibitor would be added for people whose partners had advanced AIDS.
The government already knows that doctors are prescribing AIDS drugs before they're certain of a diagnosis -- just in case they can prevent HIV from attacking the cells and reproducing.
``It's all anecdotal, but it concerns us,'' Janssen said. ``It's easy to understand how people could hear about the health care guidelines and extrapolate.''
Some doctors recommend a morning-after approach when used judiciously.
Dr. Mitchell Katz of the San Francisco Department of Public Health and Dr. Julie Gerberding of the University of California at San Francisco wrote in the April issue of the New England Journal of Medicine that coupled with proper counseling and public health campaigns, a morning-after treatment for risky sex might work.
``We believe this will save some lives, but if it sends the wrong message to the community and people practice less safe sex, we could undo the good,'' Ms. Gerberding said.
Others are skeptical when there's such little evidence that a blast of AIDS drugs would be effective.
``Disseminating an impression that there is a morning-after pill or that there will be one at this stage is dangerous,'' said Dr. Jerome Groopman of Beth Israel Deaconess Medical Center in Boston. ``The prospects of a vaccine are pretty remote. The best vaccine we have now is prevention.''
The AIDS virus is transmitted primarily through sexual intercourse and intravenous drug use. Among male AIDS patients, the CDC said homosexual sex accounts for 50 percent of the cases; heterosexual sex, 6 percent; and drug use, 23 percent. Among women, 34 percent were infected by drug use; 40 percent through sex.
Hospitals pay for the AIDS drugs when their workers get exposed. But private insurers may not cover the $300 to $600 needed for a monthlong treatment.
``It would be unlikely there would be reimbursement unless a health-care provider was able to make it a case of medical necessity,'' said Richard Koorsh, spokesman for the Health Insurance Association of America, which tracks policy issues in the insurance industry.