Post-Exposure Prevention (PEP) for Sexual, Needle Exposure Opens in New York

When a healthcare worker is exposed to HIV through a needlestick injury at work, he or she is evaluated for a short course of treatment with AZT and other antiretrovirals; the treatment must begin as soon as possible and certainly within 72 hours, and it is believed to reduce the chance of HIV infection by 80% or more. But persons exposed through sex or needle sharing seldom get any treatment, because early-intervention programs for them have been slow to develop, for various reasons.

San Francisco started a pioneering PEP program in 1998 (call 415-487-5538 24 hours a day if you may need this treatment in the San Francisco area). Data from the San Francisco program will be reported next week at the 7th Conference on Retroviruses and Opportunistic Infections (January 30-February 2) in San Francisco.

In November 1999 Gabe Torres, M.D., a well-known AIDS physician in New York, started a PEP program for the New York area, through the Bently-Salick Medical Practice, PC. The drugs and counseling are free, thanks to contributions from industry, but laboratory tests and other medical expenses are the responsibility of the patient (or their health insurance). The treatment lasts either two or four weeks, with four office visits during this time and additional followup visits at three months and six months.

The New York PEP hotline can be reached 24 hours a day at 212-358-2400.

There are also PEP programs at the Fenway Community Health Center in Boston, and in a few other cities; we do not have a complete list. While any doctor can prescribe the medications, there are medical and practical difficulties to getting treatment started in time unless planning has been done in advance.

Dr. Torres has prepared a fact sheet on PEP and his program, which we reproduce in full. For additional or more current information, see (website no longer available).

What is HIV post-exposure prophylaxis (PEP)?
HIV post-exposure prophylaxis or PEP is a potentially preventative treatment using antiretroviral (anti-HIV) drugs to treat individuals within 72 hours of a high-risk exposure to HIV.

Does PEP work?

While there is no guarantee that PEP will work, one study of healthcare workers treated with AZT after a needlestick injury has shown that PEP may reduce the chances of HIV infection by over 80%. The Centers for Disease Control and Prevention (CDC) recommends PEP for healthcare workers who are exposed to HIV-infected bodily fluids through certain work-related accidents.

What is the PEP program at Bentley-Salick Medical Practice?

Bentley-Salick Medical Practice, PC (BSMP) has developed the first New York area program to provide PEP treatment to individuals who report a recent (within 72 hours) high-risk exposure with a partner who is or is likely to be HIV infected. The pilot PEP program is open to 120 eligible patients at BSMP, a comprehensive outpatient diagnostic and treatment medical practice that provides internal medicine and infectious disease services, with expertise in delivering care to the HIV/AIDS population. The BSMP PEP program has received funding and medication to establish a 24-hour hotline and provide free drugs and counseling.* Any other medical care, lab tests, etc. are the responsibility of the patient. Most insurance plans are accepted as payment. The program provides PEP medication in conjunction with other prevention interventions, such as sexually transmitted disease (STD) screening and treatment, and a mental health program, including free behavioral counseling and adherence education. Information about patients is collected as part of a research study to evaluate the PEP program treatment and counseling and track trends in this high-risk population.

Who is eligible?

The principal eligibility requirements for the BSMP PEP program are that an individual has had receptive or insertive anal or vaginal intercourse without a condom or with a condom that breaks or comes off with a partner who is or is likely to be HIV infected. PEP is also available for injection-drug-related exposures with a high-risk partner. The exposure must have occurred within the last 72 hours, preferably the drugs should be given within 36 hours of exposure.

What about PEP for sexual or needle-sharing exposures?

There are no clinical trials or research that show PEP is effective in preventing HIV infection after sexual contact or sharing injection-drug needles. However, since PEP is recommended by the CDC for HIV-exposed healthcare workers because it reduces the chances of infection, many people believe that it should also be offered to those who are at risk from sexual or injection-drug-related exposures, especially since these are more common sources of HIV infection.

What is used for PEP treatment?

The same drugs that are used to treat HIV infection are used for PEP. A combination of several antiviral drugs is tailored to the individual patient and prescribed for up to four weeks. These are powerful drugs that are very effective in fighting HIV, but they can have side effects and must be taken at specific times of the day on a regular schedule. In addition, there is only very limited knowledge about the use of anti-HIV drugs in HIV-negative people.

What are the advantages of PEP?

PEP is intended to act as a prevention strategy that works on two levels: the first is to block the immediate HIV infection through the use of antiviral drugs, the second is to minimize the risk of future exposures by providing health care, STD treatment and risk-reduction counseling to those at high risk for HIV infection.

What are the disadvantages of PEP?

One concern is that people will return to unsafe sexual and drug-using practices if they believe PEP will prevent them from becoming infected. There is no assurance and no study has established that PEP will prevent HIV/AIDS. PEP is not a replacement for avoiding exposure to HIV. The best way to prevent HIV infection is to avoid exposure in the first place through the consistent use of condoms and clean needles for injection-drug use. Through the counseling that accompanies BSMP PEP treatment, patients are engaged in programs aimed at more effective methods of HIV prevention.

How can the program be reached?

The PEP hotline is accessible 24 hours a day at 212-358-2400. Intake counselors are available to evaluate eligibility and schedule in-person appointments. Individuals who are not eligible for the BSMP PEP program will be provided with information concerning other potential options for their care. General questions can be e-mailed to the program at pepny72@aol.com.

[*Funding and materials for the BSMP PEP program provided by Abbott, Agouron, APP Pharmacy, Bristol-Myers Squibb, Dupont Pharmaceuticals, Glaxo Wellcome, Gynetics, LifeStyles, Okamoto USA, Pharmacia and Upjohn, Roxanne and Virologic.]
Version 1.0, dated 10/14/99, IRB approval 10/14/99