Rhode Island Publishes Guidelines on Post-Exposure Treatment for HIV Exposure Among Non-Health Care Workers

Rhode Island has become the first state to publish guidelines on post-exposure prophylaxis treatment for people who are exposed to HIV outside of health care settings, the Providence Journal reports. The guidelines specify which drug regimens can reduce the risk of HIV infection if administered within 72 hours of exposure among individuals who are exposed to HIV through sexual contact, injection drug use and "other contact with HIV-infected fluids." The CDC in 1996 issued guidelines for post-exposure prophylaxis treatment for health care workers exposed to HIV (Freyer, Providence Journal, 10/30). In 1998, the agency issued guidelines for nonoccupational exposures to HIV (CDC, Morbidity and Mortality Weekly Report, 10/25/98). Although New York and California have published guidelines on post-exposure treatment for survivors of sexual assault, Rhode Island is the first state to issue guidelines for all instances of HIV exposure. Dr. Roland Merchant, an emergency physician at Rhode Island Hospital and a co-author of the guidelines, said that the state developed the recommendations because there are nearly one million non-health care workers who are exposed to HIV each year in the United States and doctors should have guidance on how to treat them. Merchant said that a month-long, two-drug regimen may be "adequate for most situations" of possible exposure; a three-drug regimen might be "more appropriate" among individuals who had contact with a person who is known to be HIV-positive. Merchant warned that post-exposure treatment should not serve as a substitute for prevention because the regimens are not "100% effective" at preventing HIV infection. The Providence Journal reports that private insurance plans and Medicaid usually cover the costs of post-exposure treatment, and sexual assault survivors who file complaints can receive money to subsidize their cost through a special state fund (Providence Journal, 10/30).