The San Francisco Examiner - Tuesday, Oct. 14, 1997
Vicki Haddock of the Examiner Staff

Instead researchers want to learn about the risks of providing such therapy after exposure to the often-lethal AIDS virus:

*Will participants stick with the regimen, casually described as "morning after" but in fact requiring weeks of drug therapy?

*Will the anti-virals produce toxic side effects in otherwise healthy people?

*Will the theory that HIV can be preempted after the fact encourage people to revert to risky sex and intravenous drug practices?

"I share those concerns, and the only way we know whether they're true is research," said Dr. Thomas Coates, the study's principal investigator and director of the UCSF Center for AIDS Prevention Studies. "There are a lot of rumors out there and some perception that this is a "drugs for bugs' program. We're trying to get the word out that it's not."

Instead he likened the study to behavioral research done in the wake of the "morning after" abortion pill, which found that RU-486 didn't prompt people to abandon traditional birth control.

The San Francisco study is open to people who fear they've been exposed to HIV within the past 72 hours - whether by a contaminated needle prick, a rape, a ruptured condom or simply risky sex.

Participants will receive immediate, free antiviral treatment for a month, medical follow-up for more than a year and intensive counseling about prevention.

Pilot program gearing up

The pilot phase is getting under way at two sites: Ward 4C at San Francisco General Hospital and the City Clinic, 356 Seventh St.

Researchers expect up to 50 participants between now and the first of the year, when the full study will open to 500 people over a three-year period.

It was developed by the prevention center, UC-San Francisco and the San Francisco Public Health Department.

The study will gather some data about how effective after-exposure therapy is in averting HIV infection, but Coates said it will take "a much more complicated long-term study" to produce an answer.

Although evidence is inconclusive, promising research suggests that infusing people with anti-viral drugs within 72 hours of their exposure to HIV - and continuing treatment for weeks afterward - may prevent infection.

AZT reduced risk of AIDS

Medical workers who took the drug AZT after they were stuck with tainted needles reduced their risk of contracting HIV by almost 80 percent, according to a 1995 study by the federal Centers for Disease Control and Prevention. Research from Tulane University and the University of Washington show that giving monkeys a blast of drugs hours after exposure slowed the attack of HIV.

Speed is crucial: The goal is to inhibit HIV from incorporating into human cells, block replication and boost the immune system's chances of banishing the invading virus.

Already many hospitals follow a CDC recommendation and administer the "morning-after cocktails" to medical workers accidentally exposed to HIV. Several private physicians have begun prescribing them to panicked patients.

Debate over public access

However, a conclave of AIDS experts convened by the CDC in July failed to agree on whether the government should put its stamp of approval on public access to post-exposure cocktails.

The idea has passionately divided AIDS specialists, especially in San Francisco.

"We don't have a potion to nullify the effects of HIV infection," said Edward Zold of ACT UP's Golden Gate chapter in an Internet column. "When the hope of nullifying the effects of exposure is framed as anything other than hope and a concept dreamed up by a few academics and drug companies hungry for profit, someone is behaving irresponsibly.

"(Post-exposure) treatment may work. Of course, it may not. We could find out by misleading young gay men and young women, filling them with false hope, and finding out afterward whether or not we were right."

In a counterpoint, fellow ACT UP-Golden Gate member Don Howard said, "What is really being said is, "We aren't going to educate you about post-exposure therapies or make them available because you can't be trusted to behave responsibly.' Withholding a potential treatment shouldn't be used to enforce safe sex.

Exposed should have option

"The real question is, if you were exposed, would you want the option of using these drugs? You should have the chance to decide. . . . We can't be silent on this issue any longer, or we will be pointing at ourselves the next time we scream HAME."

For more information about the study, call the California AIDS Hotline at 800-FOR-AIDS between 9 a.m. and 9 p.m. Monday through Friday, and from 10 a.m. to 6 p.m. Saturday and Sunday. The night time hot line number, which is available from 5 p.m. to 5 a.m., is 800-273-AIDS. Anyone seeking urgent post-exposure help can call 502-5-PEP.
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