SPEAK OUT

FIRST STEPS TO TAKE WHEN AT RISK OF HIV
EXPOSURE TO HIV AND ANTI-RETROVIRALS

Frequently asked questions about:
Risks of HIV infection Treatment
Anti-HIV drugs and how to take them
Safety and side-effects of treatment
Follow-up after exposure

HIV/AIDS Helpline 0800 110 605

How soon afte a rape and possible exposure to HIV should treatment start?
Treatment should be started within 1-2 hours after the exposure, and no more than 72 hours after initial exposure.

GENERAL INFORMATION ON EXPOSURES TO BLOOD AND BODY FLUIDS THAT MAY CONTAIN HIV -

Rape survivors and health care workers are at risk for occupational exposure to the human immunodeficiency virus (HIV). Exposures occur through needlesticks or cuts from other sharp instruments contaminated with an infected person's blood or body fluid or through contact of the eye, nose or mouth, genital area or skin with an infected person's blood or body fluid. The risk of infection varies with the type of exposure and factors such as:
The amount of blood or body fluid involved in the exposure
The amount of virus in the patient's blood or body fluids at the time of the exposure
Whether post-exposure treatment was taken
A survivor who was "dry" during the rape is often high risk because the rape would have involved injury to the vaginal area - even if it is not detectable to the human eye
Oral sex, anal sex, and gang rape all increase risk
You need to obtain anti-retrovirals, drugs such as AZT (Retrovir) and 3 TC (and if it is a gang rape Crixivan, a protease inhibitor) with 72 hours of the rape, and preferably within 24 hours - the sooner you begin taking the drugs - preferably with ONE TO TWO HOURS AFTER THE RAPE, the more effective they will be. These drugs are your first priority after a rape. However, you will first have to be tested immediately after the rape to test whether or not you are already HIV+ (this will only show if you were HIV+ before the rape, as almost a third of women reaching rape clinics already are). If you are already HIV+ it is dangerous to go onto the antiretrovirals after rape, because it is likely that they will make you ill and will interfere with your effective medical care when you get fullblown AIDS.

Ensure that medical staff also give you medication to prevent hepatitis B and hepatitis C.

RISK OF INFECTION AFTER EXPOSURE

HIV infection has been reported after occupational exposures (health workers) to HIV-infected blood through needlesticks or cuts, splashes in the eyes, nose, or mouth, and skin contact.
Risk from all exposures is probably increased if the exposure involves a larger volume of blood or sperm or a higher amount of HIV in the patient's blood or sperm. (Source-patients near death with AIDS or patients with symptoms of acute HIV infection usually have higher amounts of HIV in their blood or sperm.) with a high viral titre i.e. in the AIDS phase or early seroconversion phase stage of HIV Injury with a hollow bore needle Deep and extensive injury Drug resistance in source patient

POST-EXPOSURE TREATMENT

A study by the US Centre for Disease Control in Atlanta in September, 1998 showed that the use of RETROVIRr after HIV exposure from a needlestick or cut reduced the risk of HIV infection by approximately 81%. There have as yet - please not the qualification, there has not YET - been an instance of a rape survivor treated with antiretrovirals quickly after a rape for the full 28 days seroconverting --- but there are many cases of women, men and children becoming HIV+ after rape if they do not take antiretrovirals. These studies suggest that post-exposure treatment may prevent infection with HIV. However, because there have been reported cases of RETROVIRr monotherapy failing to prevent HIV infection in health care workers, post-exposure treatment will not prevent all cases of transmission - this is why in most rape clinics in South Africa that give the drugs to stop HIV they use AZT and 3TC, and sometimes AZT, 3TC and Crixivan, particularly after gang rapes. Nevarapine when it comes into SA will be a cheaper replacement for AZT (Retrovir) - however, rely on your AIDS specialist to guide you --- DO NOT rely on a general practitioner for HIV/AIDS advice in South Africa, most are criminally ignorant about the necessary drugs and treatment.

What Specific Drugs are Recommended for Post-exposure Treatment ?
Recommendations state that RETROVIRr, 3TCr and a protease inhibitor, such as Crixivan or indinavir, should be used as follows:
RETROVIRr should be considered for treatment of all exposures involving HIV-infected blood, fluid containing visible blood or other potentially infectious fluid or tissue.3TCr should be added to RETROVIRr for increased effectiveness and for use against zidovudine-resistant types of virus. Used in combination,
RETROVIRr and 3TCr are very effective in treating HIV infection, and they are well tolerated when used for a short time.
Indinavir or Crixivan should be added for the high risk exposures, such as those involving a larger volume of blood or sperm with a larger amount of HIV. Indinavir or Crixivan is a potent antiviral drug that appears to be well tolerated when taken for a short period.

Post-HIV exposure prophylaxis
Risk category
Antiretroviral prophylaxis
Duration
Rape is

High risk
RETROVIRr 200mg 8-hourly   28 days
3TCr 150mg 12-hourly
Indinavir or Crixivan 800mg 8-hourly
How long do the drugs need to be taken?
28 days

SAFETY AND SIDE-EFFECTS

What is known about the safety and side-effects of these drugs?

Antiretrovirals and protease inhibitors do have side effects including heacaches, diarrhoea, nauseau, forgetfulness, vomiting, sleeplessness but read the package insert, follow the instructions carefully, do not mix with other drugs without consulting your doctor, do not take alcohol. Keep remembering any side effects are less bad than being HIV+.

Some of the more frequent side-effects reported in HIV-infected patients include the following:
Upset stomach (e.g., nausea, vomiting, diarrhoea), tiredness, or
headache for people taking RETROVIRr
Upset stomach and, in rare instances, pancreatitis for people taking 3TCr
Jaundice and kidney stones in people taking Crixivan and indinavir, although these side-effects are infrequent when indinavir or Crixivan is taken for less than one month. The risk of kidney stones may be reduced by drinking plenty of fluid, at least 1.5l/day

Should pregnant women take these drugs?

If you are pregnant at the time, you should consult a physician about the use of antiviral drugs for post-exposure treatment.

FOLLOW-UP AFTER THE EXPOSURE

What follow-up testing should be done after an exposure?

Time period from exposure
Recommended tests
Baseline
Full blood count
Liver and renal function test
HIV serology
Six weeks
HIV serology
Three months
HIV serology
Six months
HIV serology

You should report any sudden or severe flu-like illness that occurs during the follow-up period, especially if it involves fever, rash, muscle aches, tiredness, malaise, or swollen glands.
You should contact your health care provider if you have any questions or problems during the follow-up period.

What precautions should be taken during the follow-up period?

During the follow-up period, especially the first 6-12 weeks when most infected persons are expected to show signs of infection, you should follow recommendations for preventing transmission of HIV. These include refraining from blood, semen, or organ donation and abstaining from sexual intercourse. If you choose to have sexual intercourse, using a latex condom consistently and correctly may reduce the risk of HIV transmission. In addition, women should not breast-feed infants during the follow-up period to prevent exposing their infants to HIV in breast milk.

PHONE FOR HELP

Glaxo Wellcome HIV/AIDS Helpline (0800 110 605) can answer questions or provide information on HIV infection and AIDS.