Outgoing California governor Gray Davis last week signed a bill instructing the Department of Health Services' State Office of AIDS to form a task force to develop guidelines for physicians to use post-exposure prophylaxis to prevent HIV infections in cases of nonoccupational exposure to the virus, including through unprotected sex. "Using PEP in cases of nonoccupational exposure to HIV saves lives and saves money," says Assemblyman Paul Koretz (D-West Hollywood), who sponsored the bill. "State-approved physician recommendations will ensure that health care providers have the basic information needed for appropriate risk assessment and proper treatment."
The cost of lifetime care and treatment for an HIV-positive person is estimated at $195,000, while the cost of PEP treatment can be as low as $640. Several health insurance companies in California, including Blue Cross and Kaiser Permanente, have recognized the financial savings in preventing HIV infections and pay for PEP treatment in nonoccupational exposures to the virus. PEP usually involves a two- to four-week treatment of antiretroviral medications begun within 72 hours of possible exposure to the virus. Studies of health-care workers exposed to HIV through accidental needle stick and splash exposures to the virus have found that PEP treatment reduces the risk of HIV infection by 81%. Studies in San Francisco also have shown that patients who have undergone PEP treatment for sexual exposures report reduced high-risk sexual behavior even one year after the treatment was completed.