UK medical students need PEP too

British medical schools should routinely provide antiretrovirals for post-exposure prophylaxis to students whilst they are working in developing countries, argue doctors from one of the UK’s leading medical schools.

Reporting the results of a national survey in this week’s edition of the British Medical Journal, they note that at the end of 2001, five of the country's 23 medical schools did not provide starter packs of antiretrovirals for postexposure prophylaxis to students spending their elective year working in a developing country. Up to 3,000 British medical students opt to work in developing countries each year on what is called an `elective`.

Medical schools that did not provide drugs had generally taken the decision because of concerns about self-administration of potentially toxic drugs, but author Anthea Tilzey said “a seven day course is unlikely to cause serious side effects and starter packs give students time to seek expert advice and follow up.”

Indeed, Guidance from the UK Chief

Medical Officers’ Expert Advisory

Group on AIDS, issued in July 2000, explicitly addressed the question of toxicity:

“Employers, medical, dental and nursing schools should consider making 7-day

starter packs of PEP drugs available to workers/students travelling to countries

where antiretroviral therapy is not commonly available. EAGA recommends that

those travelling to, and who may be occupationally exposed in countries where

zidovudine resistant virus is much less likely to be encountered, should take PEP

starter packs with them containing zidovudine in combination with lamivudine.”

“Difficulties may arise if protease inhibitor drugs are taken unsupervised. Any

student/other worker issued with a starter pack including a protease inhibitor

should be warned about increased toxicity in the event of dehydration.”

Ten of the medical schools followed this advice, while four offered triple therapy. Thirteen schools expected students to cover the cost of post-exposure prophylaxis starter packs during the mandatory elective period. In contrast, any staff working in the NHS will automatically receive post-exposure prophylaxis free of charge.

Some medical schools advised students not to carry out exposure-prone procedures, and two medical schools specifically advised avoidance of any invasive procedures in the absence of a needlestick protocol offering HIV postexposure prophylaxis.