San Francisco Chronicle - The Voice of the West, 901 Mission Street, San Francisco, CA 94119 - Saturday, July 26, 1997 - Page A3
Louis Freedberg, Chronicle Staff Writer

For the past two days, the Centers for Disease Control and Prevention brought together federal health officials, researchers and AIDS advocates to gather information on the controversial approach.

This fall, San Francisco will become the first city in the nation to begin a "postexposure treatment" program for people who think they may have been exposed to the AIDS virus. People will have to present themselves for treatment within hours of possible exposure. There is no guarantee that the rigorous monthlong regimen of combination drugs will be effective, and there will be side effects.

CDC officials did not say what actions they will take as a result of the numerous concerns raised at the meeting, but it seemed unlikely that they will issue guidelines anytime soon. Some AIDS experts fear that CDC guidelines would amount to an official endorsement of the approach. "We have not decided what we are doing on this," said Dr. Robert Janssen, deputy director of the division of HIV/AIDS prevention, surveillance and epidemiology at the CDC. "We could say it is an option, or that this is not appropriate under any scenario." Or, he said, the CDC might say that although it did not think there were enough data to support the approach, it might issue a warning to doctors who choose to proceed with the treatment anyway. Those physicians would be urged to consider a variety of factors, such as the risk of transmission, the likelihood of patients' repeating high-risk behavior and whether they will follow through on the treatment program. It was the latter option that seemed to generate the most support from the approximately 100 AIDS experts at the meeting.

Randy Pope, director of the AIDS program in Michigan, said the CDC should issue an "advisory statement" for physicians and others instead of national guidelines. Echoing a widespread sentiment, he said he feared that the postexposure treatment approach would encourage people to let down their guard and engage in high-risk behavior. "I think we could benefit from San Francisco's experience, but to implement this across the country, I don't think we're ready for this."

In support of San Francisco's program, city health officials had cited various studies, including one showing that health workers who were exposed to AIDS through needle sticks had an 80 percent lower chance of getting the HIV virus if they went through an anti-HIV virus drug treatment program within hours of being exposed. But many of those at the conference said that for a host of reasons the research could not be used to justify treating people who were not health workers.

Unlike health workers, many of those seeking treatment after possible exposure, such as injection drug users, might not know the HIV status of the person they may have been infected by. Their lives might not be stable enough to be able to follow the drug regimen, which could require taking drugs two or three times a day. Or they may have shown up too late for the treatment to be effective. "We are really flying by the seat of our pants, and hoping it is going to work," said Dr. Alfred Saah, an epidemiologist who until recently was at Johns Hopkins Medical Center in Baltimore.

Members of some San Francisco groups attending the meeting urged city health officials not to go ahead with postexposure treatment program, which is set to begin in September. "We don't think that the city of San Francisco has thought out the overall ramifications on primary prevention efforts," said Mario Solis, chief executive officer of the National Task Force on Aids prevention, which provides programs for blacks, Latinos and Native Americans in San Francisco. But Dr. Mitchell Katz, San Francisco's director of health, said that rather than being discouraged by what he heard, he was convinced that it is more important than ever for the city to proceed.

"What was said here strengthens the idea of trying to collect data on postexposure treatment so we can make better decisions, and I feel confident that will happen," he said. The first 500 people who seek treatment will be carefully monitored and assessed, Katz said. If the results show that the program is not working, it will be discontinued, he said.
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