Use of postexposure prophylaxis against HIV infection following sexual exposure does not lead to increases in high-risk behavior

AIDS. 2004 Mar 26;18(5):787-92. doi: 10.1097/00002030-200403260-00010.


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.

Design: Non-randomized trial of 397 adults with high-risk sexual or drug-use exposures within the prior 72 h.

Interventions: Antiretroviral medication for 4 weeks and five counseling sessions.

Main outcome measurements: 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.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use*
  • Female
  • Follow-Up Studies
  • HIV Infections / prevention & control*
  • HIV Infections / psychology*
  • HIV Infections / transmission
  • Humans
  • Male
  • Risk-Taking*
  • Sexual Behavior*
  • Sexually Transmitted Diseases / transmission


  • Anti-HIV Agents