The Care of Persons with Recent Sexual Exposure to HIV

doi:10.1059/0003-4819-128-4-199802150-00012

The Care of Persons with Recent Sexual Exposure to HIV

Mitchell H. Katz, MD; and
Julie Louise Gerberding, MD, MPH

From the San Francisco Department of Public Health and the University of California, San Francisco, San Francisco, California. Note: Drs. Katz and Gerberding are investigators for “Postexposure Prophylaxis: Feasibility and Consequences,” a study funded by the National Institute for Allergy and Infectious Diseases. Glaxo Wellcome, Bristol-Meyers Squibb, and Agouron Pharmaceuticals also agreed to provide drug or financial support. Drs. Katz and Gerberding receive no direct financial support from the pharmaceutical companies, and the companies did not contribute in any way to the writing of or the decision to publish the current report. Acknowledgments: The authors thank Susan Buchbinder, MD, and Joshua Bamberger, MD, for comments on earlier drafts of this manuscript. Grant Support: In part by Glaxo Wellcome, Pfizer, and Merck (Dr. Gerberding). Requests for Reprints: Mitchell H. Katz, MD, 101 Grove Street, Room 308, San Francisco, CA 94102. Current Author Addresses: Dr. Katz: 101 Grove Street, Room 308, San Francisco, CA 94102.

Abstract

Until recently, patients had little motivation to seek medical care soon after sexual exposure to HIV.However, evidence that antiretroviral treatment prevents HIV infection after occupational exposure has led to the recommendation that prophylaxis be considered after sexual exposure. This recommendation will result in an increased number of recently exposed patients presenting for care. Clinicians should seize this opportunity to reach persons who are at high risk for HIV seroconversion and provide them with evaluation, treatment, and counseling. A comprehensive approach to the care of persons recently exposed to HIV is proposed. Candidates for postexposure prophylaxis should be identified and given appropriate antiretroviral treatment. Physicians must perform HIV antibody testing to determine which persons are already infected with HIV and must do baseline laboratory studies. Follow-up care includes assessment of side effects from postexposure treatment and surveillance for development of primary HIV infection. Most important, clinicians must provide risk-reduction counseling to decrease the chance of future exposures. Public health messages must emphasize that postexposure treatment should be used only as a backup for failure of primary prevention methods, such as avoidance of high-risk sexual exposures or use of condoms.