Important note: Information in this article was accurate in 1997. The state of the art may have changed since the publication date.

Reuters NewMedia, Inc. - Thursday July 24, 1997 8:57 PM EDT

Drug therapy, already recommended for health care workers exposed to the virus on the job through accidental needle-sticks, should never be considered a first line of defense against HIV, the Centers for Disease Control and Prevention said.

"It is not the morning-after pill," said Dr. Robert Janssen, deputy director of the CDC's division of HIV/AIDS prevention, surveillance and epidemiology. "It's not a justification for turning the clock back on over a decade of behavior change. And it's not going to stop the HIV epidemic dead in its tracks."

Some people believe the drugs should be offered to rape victims, prisoners, injecting drug users, or after condom failure during sexual intercourse. However, Janssen said there has been no research on whether anti-retroviral drugs or drug combinations are effective in preventing HIV infection in non-occupational settings.

"CDC's recommendations for preventing HIV transmission have not changed," Janssen said. "Our recommendations to prevent sexual transmission through abstinence or consistent and correct condom use still remain."

At a two-day CDC scientific meeting on drug therapies, Janssen said their widespread use could cause HIV to become more resistant to treatment. The virus constantly mutates and some HIV strains grow in the presence of anti-retroviral agents. "If that strain of virus gets transmitted to a person, that person now has a virus that won't respond to (the drug) AZT, for example," Janssen said.

The CDC plans to propose guidelines for non-occupational use of the drugs late this year. Some doctors and hospitals have already begun to prescribe the drugs to rape victims or people who fear infection because of sexual activity.

The drugs used for post-exposure therapy cost between $600 and $1,000, are usually not covered by insurance, and must be taken several times a day for four weeks. The medications can have severe side effects and using them in combination with illicit substances may be lethal.

Despite the cost, a Georgia State University survey of 327 gay and bisexual men in Atlanta who were sexually active with more than one partner found 26 percent planned to obtain the drugs for HIV prevention.

Michael Bellfountaine of ACT-UP in San Francisco said offering the treatments to people who fear HIV infection squanders scarce resources. "That money and that access to drugs had got to go to people with AIDS," he said.

Studies have shown that giving the drug AZT to an HIV- infected pregnant mother and her newborn infant can reduce the risk of virus transmission to the baby by as much as two-thirds. A 1995 CDC survey of health care workers in France, the United Kingdom and the United States found that post-exposure use of AZT reduced their risk of HIV infection by 79 percent.

Research on animals presented at the CDC meeting indicated that post-exposure therapy is most effective when it starts with hours of exposure.

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