U.S. URGES WIDER USE OF AIDS TREATMENT

ATLANTA - In a major policy shift, the government recommended for the first
time Thursday that people exposed to the AIDS virus from rapes, accidents
or occasional drug use or unsafe sex receive drug cocktails that can keep
them from becoming infected.

Previously, federal health officials recommended emergency drug treatment
only for health care workers accidentally stuck with a needle, splashed in
the eye with blood or exposed in some other way on the job. That
recommendation was first made in 1996.

The Centers for Disease Control and Prevention expanded its guidelines to
rape victims and many others Thursday. It said treatment should start no
more than 72 hours after a person has been exposed to the virus, and the
drugs should be used by patients for 28 days.

It is a major shift away from a policy that some doctors had called
unconscionable and that put the United States years behind much of Europe
and other nations.

"The severity of the HIV epidemic dictates we use all available tools to
reduce infection," said Dr. Ronald Valdiserri of the CDC.

He stressed that emergency drug treatment is a "safety net," not a
substitute for abstinence, monogamy and the use of condoms and sterile needles.

"It is clearly not a 'morning-after pill,' " he said.

People accidentally exposed to the AIDS virus are usually given a
three-drug combination that includes AZT and 3TC.

In tests on primates, drug cocktails prevented infection with the monkey
version of HIV 100 percent of the time if given within 24 hours of exposure
to the virus, and 52 percent of the time if administered within 72 hours,
said Dr. Charles Gonzalez, assistant professor of medicine at New York
University School of Medicine and a member of the New York State AIDS
Institute medical-guidelines board.

However, there is no data from clinical trials on how effective the drugs
are in stemming HIV infection in people.

The new guidelines do not bind the U.S. government to pay for the treatment
regimen through Medicare or Medicaid, and no federal money has been
allocated to help doctors and health departments carry out the recommendations.

European countries, Australia and Brazil have long had guidelines calling
for the use of HIV drugs to prevent infection in rape victims. Without a
national policy in the United States, New York, California, Massachusetts
and Rhode Island and cities such as San Francisco and Boston came up with
their own such guidelines.

"It's unconscionable they didn't have a policy for rape victims. It's just
ludicrous. They knew they were well behind the curve," Gonzalez said.

The CDC said it hesitated to recommend wider use of AIDS drugs because it
did not have enough information on their effectiveness. But the agency said
better information has been gathered over the past several years from
animal and lab studies and from state and city programs that offer HIV
drugs to rape victims and others.