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'Morning After' Pill Regimen May Keep AIDS at Bay

But controversy, side effects limit use of treatment

TUESDAY, Jan. 1, 2002 (HealthDayNews) -- Just had unsafe sex? Call your doctor in the morning, prepare to take a month's worth of potentially unpleasant pills, and you may -- just may -- dodge AIDS.

For several years, that has been the quiet advice of some doctors who deal with people at risk of getting AIDS because of unsafe sexual encounters.

It's the same drug regimen -- endorsed by the federal government -- that is designed to prevent the deadly disease in medical workers who may have been infected with HIV on the job.

But the "morning after" therapy for unsafe sex remains a little-known option for a variety of reasons.

For starters, critics question the drug regimen's effectiveness; studies have shown it's not foolproof. Opponents also wonder if the therapy is a wise use of money and resources. Most worrisome, they add, is the prospect that more people will engage in unsafe sex if they know there's a pill they can take afterwards that might protect them.

"It's more important to practice safe sex regularly than have this idea of a fall-back pill that's probably not going to work," says Greg Gonsalves, the director of treatment advocacy at the Gay Men's Health Crisis, a leading AIDS organization based in New York City.

In the late 1980s, scientists wondered if the then-new AIDS drugs, now known as protease inhibitors, would help fight off the disease in medical professionals who accidentally had contact with the blood of HIV-positive patients. Since then, studies have shown the medicine does appear to prevent AIDS in many cases, says Michael Allerton, HIV operations policy leader for the Permanente Medical Group in Northern California.

But the treatment is no guarantee. One widely quoted study published in The New England Journal of Medicine showed it worked only 80 percent of the time. "It isn't foolproof, but it's the best we have and it does seem to have an effect," Allerton says.

The federal government has issued guidelines for the treatment of health-care workers. The therapy, known as "post-exposure prophylaxis," should begin immediately after the possibility of infection, and no more than 72 hours later.

Over time, some medical officials wondered whether the drug regimen would work for people possibly exposed to HIV through unsafe sex or the sharing of infected needles. Two years ago, officials in San Francisco finished a study of 400 people who took the treatment after having unsafe sex. After six months, none had become infected with HIV, the virus that causes AIDS.

But the outcome might have been the same regardless of whether they took the drugs because not every unsafe sex encounter will result in HIV infection, says Dr. Joshua Bamberger, a medical director with the San Francisco Department of Public Health.

The study's main lesson was that intensive counseling about safe sex practices is the best way to reduce rates of infection, Bambergers says.

People on the AIDS treatment -- whether health-care workers or not -- usually take a month's worth of drugs every day at a cost that can run as high as $1,400.

The biggest drawbacks to the regimen are the serious side effects, which can include nausea, headaches, vomiting and diarrhea. Some people get so sick, they stop the medication before the month is up.

In a recent issue of New York magazine, writer Glenn Gordon described his experience with the drugs after he'd had an unsafe sexual encounter with a gay tourist. He recalled bouts of vomiting and diarrhea. The most disturbing side effects, however, were vivid, upsetting dreams.

But critics like Gonsalves question whether people like Gordon -- who did not become infected -- should get the drugs at all.

His big concern is that people might abandon safe sex if they know there's a drug they can take if things go wrong. "Is it going to be used every time you have unsafe sex?" Gonsalves asks. "Are you going to go get pills each time?"

But many medical professionals like Bamberger think anyone should be able to get the treatment.

"A health department or governing body shouldn't stand in the way of an individual getting access to a life-saving medication," Bamberger says. "There's a clear contradiction that it's recommended for people who get needle sticks in an occupational setting, but it's [sometimes] not offered to people who have sexual exposure or share contaminated needles."

In his New York article, Gordon wrote that he doesn't foresee a drop in safe-sex practices if the drug regimen becomes more popular: "I can attest that a month on the AIDS drugs is a far more chilling prospect than wearing a condom."

What To Do

As always, the best ways to avoid AIDS are through abstinence or monogamy or the use of condoms. If you do have unsafe sex, you may wish to contact your doctor immediately to discuss the AIDS drug regimen. If your doctor isn't familiar with it, try your nearest AIDS organization.

Check out this fact sheet on the AIDS regimen from the New Mexico AIDS Infonet project.

Many people still believe you can't become infected with HIV during oral sex. But research has proven that's just not true. To learn more, visit this U.S. Centers for Disease Control and Prevention Web site. (To read the report, you'll need the Adobe Acrobat Reader. To download it, click here.)

SOURCES: Interviews with Michael Allerton, HIV operations policy leader, Permanente Medical Group of Northern California, Oakland; Joshua Bamberger, M.D., MPH, medical director for housing and urban health, San Francisco Department of Public Health; Greg Gonsalves, director of treatment advocacy, Gay Men's Health Crisis, New York City
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