Is the conventional view and treatment of AIDS
Postexposure prophylaxis is a relatively short course of anti-retroviral drugs offered to health care workers after occupational exposures to blood thought to be HIV infected. The hypothetical assumption is that this reduces the risk of seroconversion to HIV positive.
Being stuck with a needle that has HIV infected blood, as has happened to
thousands of health care workers, is a terrifying experience, but it very rarely
results in HIV infection. Studies of such exposures find that only about 1 in
333 people who experience HIV-infected needle sticks seroconvert (Cardo
1997, Gerberding 1994, Henderson 1990), and that a total of only about 50
seroconversions from infected needles have been reported worldwide since
HIV was targeted as the cause in 1984. This is an incredibly small number
when compared to other blood borne diseases that are of similar prevalence.
Serious problems with PEP treatment have been evident for some time. In one study published in the Annals of Hematology in 1994 (Ann Hematol. 1994 Sep;69(3):135-8) AZT was given to 14 health care workers who were exposed to HIV-contaminated blood through needle sticks and similar accidents. Fully half of the 14 workers had to quit the drug because of severe toxic side effects, and the study was stopped early before more damage was done. Only 11 of the 14 people could continue to take the drug for more than four weeks. Neutropenia developed in 36% (4 of 11) of the people who completed 4 weeks of AZT treatment. The three people who could not make it to four weeks dropped out due to "severe subjective symptoms". One worker had to be stopped prematurely because his neutropenia was so severe that he developed an upper respiratory tract infection. This recent report also urges caution:
Serious Adverse Events Attributed to Nevirapine Regimens
for Postexposure Prophylaxis After HIV Exposures ---
Worldwide, 1997--2000"
"Risks of Nevirapine Likely Outweigh Benefits for Occupational HIV Post-Exposure Use: In September, 2000, CDC received two reports of life-threatening hepatotoxicity (liver damage) among health care workers taking nevirapine for post-exposure prophylaxis (PEP) after occupational exposure to HIV. Nevirapine has not been recommended for PEP use and has previously been associated with instances of serious skin conditions, liver damage, and death when used for treating HIV-infected individuals. The recent reports prompted a review of FDA's registry of serious adverse events, which identified 20 other reports of serious side effects among people who had taken nevirapine for PEP. These 22 cases, in healthy, uninfected individuals who took the drug for a relatively short period of time (2 weeks, on average, before onset of symptoms) are cause for serious concern. Anyone considering PEP should consult with their physician to carefully weigh the risks of HIV infection related to their exposure, the potential benefits of post-exposure therapy, and the possible side effects of any PEP regimen. Recommended regimens are outlined in Public Health Service Guidelines for the Management of Health-Care Worker Exposures to HIV and Recommendations for Postexposure Prophylaxis" (MMWR, Vol. 47, RR-7, May 15,1998; available online at www.cdc.gov/hiv/treatment.htm.) In most circumstances, the risks associated with nevirapine as part of an occupational PEP regimen might outweigh the anticipated benefits."
U.S. Warns on Some Use of a Fighter Against H.I.V.
Equally serious adverse events have been reported among people who had taken PEP regimen other than nevirapine (see below).
PEP has been prescribed as a “morning-after” treatment for HIV infection after unprotected sex. PEP is a 4 to 12 week chemotherapy regimen of AZT and may include DDI, DDC, 3TC, etc. and protease inhibitors. Here are some things to consider: Chances of becoming HIV infected through ONE incident of unprotected intercourse:
unprotected receptive anal intercourse:Other sources have different statistics: unprotected receptive vaginal intercourse: 1 in 1000The scientific data in favor of PEP is sparse. The CDC cited just two human studies; one on mother-to-child transmission (regarding a completely different drug regimen); the other studied the use of AZT for health care workers exposed mainly by needle pricks. THERE IS NO EVIDENCE THAT PEP WILL BE EFFECTIVE AFTER UNPROTECTED SEX OR SHARING NEEDLES. Animal testing has suggested that PEP would only be effective if started within hours after HIV exposure. The PEP therapy is HIGHLY TOXIC. Three quarters of the health care workers on PEP experience serious side effects. On third of these HCWs have to discontinue PEP because the side effects are too severe. One has to weigh the relatively low chance of infection from a single possible exposure against the known toxicities of PEP treatment. In the literature published on PEP, concerns were raised repeatedly about the SERIOUS TOXIC SIDE EFFECTS of the drug “cocktail”. We should reflect on the fact that HIV positive patients are put on these drugs INDEFINITELY - not just for 4 to 12 weeks.
HAART "is not candy"! ATLANTA (AP) -- Government health officials warned doctors Thursday that prescribing AIDS drugs as a ``morning-after'' treatment for people who have been exposed to the virus through sex and drugs carries heavy risks and hasn't been proved successful. The Centers for Disease Control and Prevention said doctors should not give the treatment to patients on demand. Although early doses of AIDS drugs appear to have stopped some infections among medical workers exposed to tainted blood and among newborns of infected women, there is still no proof such treatment would be effective with the general population, the CDC said. The risks range from nausea to hepatitis, the agency said. ``This is not candy you just give out to make patients feel better,'' said Dr. Dawn Smith, a CDC epidemiologist. AP-NY-09-24-98 1622EDT
"Some health-care providers have proposed offering antiretroviral drugs to persons with unanticipated sexual or injecting-drug-use HIV exposure to prevent transmission. However, because no data exist regarding the efficacy of this therapy for persons with nonoccupational HIV exposure, it should be considered an unproven clinical intervention." "The risk for HIV transmission per episode of receptive penile-anal sexual exposure is estimated at 0.1%-3%; the risk per episode of receptive vaginal exposure is estimated at 0.1%-0.2% (7). No published estimates of the risk for transmission from receptive oral exposure exist, but instances of transmission have been reported (8,9)." "Side Effects and Toxicity of Antiretroviral Agents "The frequency, severity, duration, and reversibility of side effects must be weighed against the usefulness of antiretroviral agents for any patient. All antiretroviral agents have been associated with side effects. Adverse events have been reported for persons with advanced HIV disease (and longer treatment courses), but persons with less advanced disease or those who are uninfected might have different experiences (27). Many side effects can be managed symptomatically, but when the probability of transmission is low, one must weigh this probability against the risk of a severe side effect. Although the most common side effects are mild, studies have demonstrated that 50%-75% of health-care workers receiving ZDV alone for possible HIV exposure reported one or more subjective complaints, and as many as 35% did not complete the full course of therapy because of side effects (6,28,29). Preliminary information on health-care workers receiving combination therapy for postexposure prophylaxis demonstrated that 50%-90% reported subjective side effects and 24%-36% reported side effects severe enough to discontinue therapy (30-33). "Many antiretroviral agents are associated with gastrointestinal side effects (e.g., nausea, vomiting, and diarrhea). In general, using combinations of agents has not caused more instances of adverse effects, but serious drug interactions have occurred when antiretrovirals were used with certain other medications. Current medications must be evaluated before patients are prescribed any antiretrovirals, and health-care providers must monitor patients closely for toxicities. Protease inhibitors recently have been associated with the occurrence of lipid abnormalities (34-36), as well as the development of diabetes mellitus, hyperglycemia, and diabetic ketoacidosis, and they can exacerbate preexisting diabetes mellitus (27,37). Some health-care workers using combination drugs for postexposure prophylaxis of occupational HIV exposure have developed serious side effects -- including nephrolithiasis, hepatitis, and pancytopenia -- sometimes within 3 days of initiating therapy (31,32,38)."
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