Ministry to Offer anti-HIV Cocktail to At-risk Public

New guidelines make intravenous drug users and people who had unprotected sex eligible for drugs

The Health Ministry has for the first time issued directives for treatment with medications to prevent the transmission of HIV following unprotected sex. The regimen, which lasts over a month, is the same given to healthcare workers exposed to blood and to victims of sexual assault.

According to the directives, the treatment will also be available to drug injectors who fear they might have been exposed to another person's blood.

The guidelines are an attempt to stem the rise in recent years in HIV infections, particularly in the gay community. In 2008, 390 people were diagnosed as HIV positive, the largest number in a decade, according to the Health Ministry.

At the end of 2008, the official count of people who were HIV positive in Israel was 4,525, but the Health Ministry said the real figure could be as high as 6,374.

According to the directives, issued by Prof. Itamar Grotto, the ministry's director of public health services, the risk of contracting HIV through an infected needle is low, less than 1 percent.

The risk is also low from a single unprotected sexual encounter, and depends in part on sexual practices, sexual history and whether a sore or an ulcer was present on the sex organs. The so-called viral load in the body fluids of the sex partner is also a factor. Immediate and consistent use of the medication apparently significantly decreases the risk of infection.

Body fluids that can transmit the virus include blood, tissue, semen, vaginal secretions, breast milk and secretions from pressure sores. Exposure can be from a needle or other sharp object or by coming in contact with mucous membranes, damaged skin, or undamaged skin if exposure is continuous.

The directives instruct people who have been exposed to HIV through unprotected sex to seek treatment at a hospital emergency room. They should also find out as many details as possible about their sex partner.

The ER doctor is to consult with the AIDS center at the nearest regional hospital, and a physician at that facility is to decide on whether treatment should be administered, with victims of sexual assault given first priority. Treatment should begin no more than 72 hours after exposure.

Exposure to body fluids that do not transmit the HIV virus, like saliva, tears, sweat, mucus, phlegm, vomit, urine and feces, do not require treatment, even if the other person is known to be HIV positive.

Treatment is given once or twice a day for at least a month with two medications - one in the category known as nucleoside reverse transcriptase inhibitors (Truvada or Combivir ) and the other a protease inhibitor (Kaletra or Prezista ).

If treatment is approved, it is covered by the health basket.

"Medications today are more effective and have fewer and less-severe side effects than the previous generation," said Dr. Zohar Mor, the head of Health Ministry's TB and AIDS department.

But Mor adds that the treatment does have side effects, especially on the digestive system, and may also produce anxiety or depression. "Therefore the decision to give the medications must be considered carefully," Mor said.

The new directives say AIDS center physicians can suggest alternative treatment, and are to discuss the efficacy and risks of various treatments with a patient who has been exposed. Patients also must be informed of the importance of follow-up and begin treatment as soon as possible - if possible within two hours of exposure.