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Less May Be More in Treating Early HIV

Fewer people discontinue treatment with milder regimen

TUESDAY, March 29, 2005 (HealthDay News) -- In people who worry they've just been infected with HIV, it may make more sense to combat the virus with a milder drug regimen, new research suggests.

A Brazilian study found that sexual assault victims who took two HIV-suppressing drugs rather than three suffered fewer side effects and were more likely to finish their treatment -- adding to the debate over whether a stronger regimen would be better.

"This has been a bone of contention," said Dr. Roland C. Merchant, assistant professor of emergency medicine at Brown University. "There's a debate over side effects and how much they might affect whether or not patients will take the drugs and adhere to the regimen."

The treatment of people who might be newly infected with HIV entered the spotlight in January when the federal government issued new guidelines. Officials recommended that doctors consider prescribing a 28-day drug regimen to people who are at risk of HIV infection because of sexual assault or unprotected sex.

The treatment, known as post-exposure prophylaxis, has long been available and is designed to begin within 72 hours after possible exposure to the virus. Doctors offer it to sexual assault victims, health-care workers accidentally exposed to blood on the job and people who have had unprotected sex and fear they may have been infected.

But these powerful HIV-suppressing drugs come with a variety of side effects, and health officials have worried that people may not finish their treatment because of the side effects.

In the Brazilian study, researchers examined the records of 278 sexual assault victims who were offered the treatment between 1997 and 2001. They found that 93 percent of those who took three types of AIDS drugs reported side effects, compared with 66 percent of people who took two. The most common side effects were digestive problems and malaise.

Nearly 70 percent of those who took two drugs finished their treatment, compared with 53 percent of those who took three drugs. The findings appear in the April issue of the journal Sexually Transmitted Diseases.

"Every person responds differently to each medication," said Dr. Michelle Roland, an assistant professor of medicine at the University of California at San Francisco. "Some will have no side effects, some mild, some awful." Roland recently studied how South African sexual assault victims responded to post-exposure treatment, and she, too, found that side effects were common.

However, she said, "it's impossible to know if the symptoms are actually side effects, or how much they are related to the stress of the assault or non-assault exposure and the fear of HIV."

Roland said her study "provides some reassurance that, with appropriate support, folks are able to complete their meds without horrible side effects."

Merchant, the Brown University professor, said the Brazilian findings reflect those reported in earlier studies. Some specialists believe the evidence does not support the use of three drugs in most cases, he said, and federal guidelines seem to follow that advice.

"They use a graduated approach," Merchant said. "The more likely that someone has been exposed to HIV, the more that person should take [more] drugs instead of fewer drugs."

The question remains whether post-exposure prophylaxis truly works. One study of health-care workers suggested it does, but little other data exists, partly because of ethical issues: What person exposed to HIV would volunteer to not be treated?

However, the Brazilian researchers did report that none of 180 patients tested HIV-positive after completing the 28-day treatment.

"With all the evidence, [post-exposure prophylaxis] seems to be a reasonable way to go," Merchant said.

More information

Learn more about post-exposure prophylaxis from aids.org.

SOURCES: Michelle Roland, M.D., assistant professor, medicine, University of California at San Francisco; Roland Merchant, M.D., assistant professor, emergency medicine, Brown University, Providence, R.I.; April 2005 Sexually Transmitted Diseases
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