Media Release

For Immediate Release: September 25, 2002

State Department of Health Announces Release of HIV Post Exposure Guidelines
RI First State to Produce Comprehensive Guidelines for Nonoccupational HIV Exposures

The Rhode Island Department of Health announced recently published guidelines for treating people who are not healthcare workers who may have been exposed to HIV, the virus that causes AIDS. The guidelines, the first written in the United States for all types of nonoccupational HIV exposures, are voluntary and apply to people who might have been exposed through sexual contact, other exposure to HIV-infected fluids, needle sharing and exposure to a needle or another object possibly infected with HIV."Healthcare providers should seriously consider using antiretroviral drugs for post exposure prophylaxis (NPEP) in nonoccupational situations," said Patricia A. Nolan, MD, MPH, director of the RI Department of Health. "These guidelines provide a step-by-step approach for evaluating and managing people exposed to HIV as a result of sexual assault, high risk sexual behavior, IV drug use or other ‘nonoccupational’ incidents. In conjunction with a strong, primary prevention program, NPEP provides an important strategy for addressing HIV/AIDS and assuring a safe and healthy RI community."The Centers for Disease Control and Prevention (CDC) issued guidelines in 1996 for "occupational" HIV PEP, which were updated in 2001, that help guide the administration of HIV post exposure prophylaxis to healthcare workers. The CDC has not composed guidelines for the so-called "non occupational" incidents which comprise the major routes of HIV transmission, namely sexual encounters and injecting drug usage. Rhode Island is the first state to introduce guidelines for all types of "nonoccupational" exposures. Two other states, California and New York, have issued guidelines which only pertain to sexual assault. The Rhode Island NPEP guidelines were created by a consensus group of Rhode Island clinicians and members of community groups that serve people impacted by possible HIV exposures. A complete copy of the guidelines is available on the RI Department of Health and Brown University AIDS Program Web sites. A summary of the guidelines was published in Medicine and Health Rhode Island, a publication of the Rhode Island Medical Society.Roland Merchant, MD, of Rhode Island Hospital authored the guidelines with Kenneth Mayer, MD, of The Miriam Hospital, and Carol Browning, MS, RN, C, of the RI Department of Health’s Office of HIV and AIDS."There were 147 new cases of HIV reported in Rhode Island in 2001 despite community based prevention efforts," said Dr. Mayer, who is also a professor of medicine and community health at Brown Medical School and director of the Brown University AIDS Program. "These guidelines may help to prevent some new infections."The guidelines detail what antiretroviral drugs should be administered for those who may have been exposed to HIV and under what circumstances they should be administered. However, the guidelines emphasize that preventing HIV through reducing risky behavior is best, and that NPEP is not a safety net for those who knowingly engage in unsafe sex, needle sharing and other risky behaviors.According to Dr. Merchant, principal author of the NPEP guidelines and an emergency medicine physician at Rhode Island Hospital, "The Rhode Island HIV NPEP guidelines are intended as a resource for clinicians whose patients may have been exposed to HIV within the prior 72 hours. We hope that NPEP may help those where primary prevention efforts have failed or were not possible for a given circumstance, such as survivors of sexual assault."

NPEP appears to be a promising means of preventing HIV infections. In a San Francisco study conducted from 1997 to 1999 none of 300 patients who were exposed to HIV and received NPEP with follow up care became infected with the virus six months after they started treatment. Another study in Massachusetts found that none of 74 participants who completed NPEP and follow up treatment were HIV positive when tested 4 to 6 weeks after they finished treatment.

Roland Merchant, MD, of Rhode Island Hospital, Kenneth Mayer, MD, of The Miriam Hospital and Carol Browning, MS, RN, C, of the RI Department of Health, are available for interviews. Please call Eric White (401) 444-7480 or Polly Stiness (401) 444-3955 to make arrangements.