title: Use of postexposure prophylaxis against HIV infection following sexual exposure does not lead to increases in high-risk behavior.
abstract: BACKGROUND
  The effectiveness of postexposure prophylaxis (PEP) following occupational exposure to HIV has prompted advocacy for PEP following sexual or drug-use exposures.
  
  
  OBJECTIVE
  To evaluate the concern that the availability of PEP for sexual or drug-use exposures might result in behavioral disinhibition.
  
  
  METHODS
  Non-randomized trial of 397 adults with high-risk sexual or drug-use exposures within the prior 72 h.
  
  
  METHODS
  Antiretroviral medication for 4 weeks and five counseling sessions.
  
  
  METHODS
  Participants were followed for 12 months for repeat request for PEP and for changes compared with pre-enrollment in overall high-risk behavior and the acquisition of sexually transmitted diseases (STD) and HIV.
  
  
  RESULTS
  After 12 months following receipt of PEP, the majority of participants (83%) did not request a repeat course of PEP. At 12 months after exposure, 73% of participants reported a decrease compared with baseline in the number of times they had performed high-risk sexual acts; 13% reported no change, and 14% had an increase. Most participants (85%) had no change in the incidence of STD; 8.5% had a decrease and 6.8% an increase. Three homosexual men seroconverted for HIV (none associated with the presenting exposure) for a rate of 1.2/100 person-year, equivalent to rates in San Francisco among all homosexual men.
  
  
  CONCLUSIONS
  After receipt of PEP consisting of antiretroviral medication and behavioral counseling following a potential sexual exposure to HIV, most individuals do not increase high-risk behavior. Coupled with prior safety and feasibility data, this lack of behavioral disinhibition suggests that use of PEP should be routinely considered following high-risk sexual exposures.
authors.affiliation: Department of Epidemiology and Biostatistics, the Center for AIDS Prevention Studies, and San Francisco, California 94105, USA.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Martin
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Roland
authors.forename: Torsten B
authors.initials: TB
authors.lastname: Neilands
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Krone
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Bamberger
authors.forename: Robert P
authors.initials: RP
authors.lastname: Kohn
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Chesney
authors.forename: Karena
authors.initials: K
authors.lastname: Franses
authors.forename: James O
authors.initials: JO
authors.lastname: Kahn
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Coates
authors.forename: Mitchell H
authors.initials: MH
authors.lastname: Katz
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology* / Q000635:transmission; D006801:Humans; D008297:Male; D012309:Risk-Taking; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000635:transmission
chemical_list: D019380:Anti-HIV Agents