Thursday, September 22, 2016

How does PEP works?

PEP is recommended because it has been observed that systemic infection does not occur immediately after an exposure and there is a brief window period of opportunity  available to contain or eradicate HIV from body before wide spread cellular infection occur. After a needle-stick injury, immune cells (dendritic) in skin present the  HIV to T-lymphocytes and natural killer cells. It is seen that in monkey models, Simian immunodeficiency virus (SIV) when injected into vagina, virus is engulfed by immune cells in the vaginal lining. Within 2 days SIV is found in inguinal lymph nodes. Within 5 days SIV infected T-cells and free SIV can be detected in blood stream  9. Migration of SIV after rectal or penile tip exposure follows a similar time frame. PEP can stop viral replication during this early period before it gains a 'foothold' in the body. 

Determination of the Exposure Code in PEP

Exposure code can be defined as per the flow chart given below. It may be classified into three categories, EC-1, EC-2 and EC-3, depending upon the severity of exposure.

Sunday, September 18, 2016

PEP Initial Evaluation

What is considered to be a potential exposure to HIV, HBV or HCV?
For transmission of blood borne pathogens (HIV, HBV and HCV) to occur, an exposure must include both of the following:
• Infectious body fluid
o Blood, semen, vaginal fluids, amniotic fluids, breast milk, cerebrospinal fluid, pericardial fluid, peritoneal fluid, pleural fluid and synovial flood can transmit HIV, HBV and HCV.
• Note that saliva, vomitus, urine, feces, sweat, tears and respiratory secretions do not transmit HIV (unless visibly bloody). The risk of HBV and HCV transmission from non-bloody saliva is negligible.
• A portal of entry
(percutaneous, mucous membrane, cutaneous with non-intact skin).
If both of these factors are not present, there is no risk of transmission and further evaluation is not required.

What baseline testing should be performed after an exposure?
(If no exposure occurred or Source Person tests negative, no testing is clinically indicated. Testing may be considered for other purposes including medico legal concerns or as per institutional protocols.)
Source Person (SP):
• HIV Ab (rapid HIV Ab testing preferred if accessible)*
• HCV Ab
• HBV surface Ag
*If SP’s rapid HIV Ab test is positive, assume this is a true positive and send confirmatory testing, usually with a Western Blot test. See below*.
Exposed Person (EP):
• HIV Ab
• HCV Ab
• HBV testing: Depends on immunization status.
Note that most healthcare and public safety personnel have been vaccinated against hepatitis B. If previously vaccinated and they know they responded to the vaccination series (a positive titer is >10mIU/mL, but most do not know their titer), they are considered to have lifelong immunity and require no further testing or treatment. Similarly, if employee health records indicate they responded to the vaccination series, they are considered to be immune. For all others, see the “Exposures to HBV and HCV” section of this guide.

*Is the rapid HIV test accurate enough to decide on whether to give PEP?
Yes, the rapid HIV test is extremely sensitive and specific and can be used to determine whether to offer PEP. A positive rapid HIV test should be considered a true positive for the purposes of PEP decision-making. A negative rapid test should be considered a true negative. Investigation of whether a source might be in the “window period” is unnecessary for determining whether HIV PEP is indicated unless acute retroviral syndrome is clinically suspected.

Friday, September 16, 2016

How PEP Works

We don’t have a cure for HIV, but we do have the next best thing: Prevention. In addition to condoms, clean needles, and public education, there is a now a new tool in the fight against the spread of HIV: post-exposure prophylaxis (PEP) medication. Also known as the HIV morning-after pill, these drugs help to drastically reduce the risk of contracting HIV if taken soon after exposure. Here’s what you need to know to keep yourself and your loved ones safe.

PEP is an antiretroviral medicine (ART) taken after potential exposed to HIV to prevent becoming infected. According to, PEP must be started within 72 hours after a recent possible exposure to HIV, but the sooner you start PEP, the better.

Once prescribed PEP, you will need to take it either once or twice daily for 28 days. The drugs work by helping the immune system to stop the virus from multiplying inside the body’s cells. According to Get, cells that are already infected usually die naturally within a short period of time, and without means of reproducing, the virus is unable to spread and therefore infect an individual.

Unfortunately, PEP is not 100 percent effective at preventing HIV infections. In some cases, patients do not take the drug at the prescribed dosage for the prescribed amount of time. Other times, patients are infected with a strain of HIV which the drugs cannot work against, or the initial viral exposure was too great for the drugs to be effective.

The drugs are often given to those who believe they have been exposed to HIV, either through unprotected sex, shared needles, or victims of sexual assault. In addition, the drug costs between $600 and $1,000 and is meant to be used only in emergency situations, and should not be the go-to means of protection against the virus. Those who are possibly often exposed to HIV, such as individuals with HIV-positive partners, are advised to instead take PrEP, a daily drug that works similarly to lower infection risk.

PEP can have minor non-life threatening side effects such as nausea. Those who cannot afford to pay for the drug may qualify for either reimbursement or free medication through special programs.

Thursday, September 15, 2016

What is emergency HIV treatment?

Do you think you have been exposed to HIV within the last 72 hours?

If yes, you may be able to get treatment to prevent HIV infection.

Post-exposure prophylaxis, or PEP, is another name for emergency HIV treatment. PEP is not a cure for HIV, it is a form of HIV prevention. It is a short course of antiretroviral drugs that stops exposure to HIV from becoming a life-long infection.

Taking PEP
PEP can cause side effects such as nausea and fatigue. DO NOT stop taking PEP - talk to your healthcare professional.
PEP must be taken as soon as possible to be effective and no later than 72 hours after exposure to HIV.
PEP must be taken at the same time every day for 4 weeks.1

Can I get PEP?
Not everyone is given PEP and it is not available everywhere. A healthcare professional will advise you if they think you should take PEP. Do not assume you will be offered it.

Usually you should only take PEP if...
it has not been longer than 72 hours since exposure to HIV
you are not already living with HIV
a mucous membrance (including: eyes, mouth, vagina, rectum) has had direct contact with someone’s bodily fluid that might be infectious
an open wound has had direct conact with someone’s bodily fluid that might be infectious
the source of exposure is infected with HIV or their HIV status is unknown.

PEP and HIV testing
It’s normal to feel anxious about being infected with HIV. Don’t let being worried stop you from getting an HIV test.

If you took PEP - get tested 3 and 6 months after potential exposure.
If you didn’t take PEP - get tested 3 months after potential exposure.
PEP in pregnancy

Certain PEP drugs can be taken during pregnancy. However, some drugs should not be used for PEP if you are pregnant. Speak to a healthcare professional about your options.

PEP during breastfeeding
PEP can be taken when breastfeeding. PEP reduces the chance of passing HIV to your baby via breastfeeding. Follow the advice of your healthcare professional and national breastfeeding guidelines.

PEP after sexual assault
If you have been sexually assaulted seek urgent medical help. A healthcare professional will advise you what to do next and they may suggest taking PEP.

Assault is never your fault. You have the right to report it to your local authority if you want to.

You might also need...
Urgent treatment for other sexually transmitted infections (STIs) or blood borne viruses.
Emergency contraception to prevent unwanted pregnancies:
the morning after pill must be taken within 72 hours
the intrauterine device (IUD or coil) can be fitted within 5 days of unprotected sex.
Emotional support, advice and counseling

Getting the right support is important before, during and after taking PEP. It can help address any concerns or fears that you might have. Attend follow-up visits with your healthcare team regularly.

PEP must not be used as a frequent way to prevent HIV infection. Use condoms and safer sex practices to prevent sexual transmission of HIV.

Where to get PEP?

If you think that you have been exposed to HIV visit a healthcare clinic, doctor or pharmacy immediately.

You have the right to:

enquire about PEP
refuse PEP
have confidential support and advice
stop taking PEP.

Tuesday, September 13, 2016

Can PEP stop HIV?

Post-exposure prophylaxis (PEP) may stop you developing an HIV infection if you’ve been exposed to the virus. However, it doesn’t always work.
You may have been exposed to HIV if you've:
had unprotected sex (without using a condom)
had sex with someone with HIV and the condom broke
been injured with an HIV-infected needle

What is PEP?
PEP is a course of anti-HIV medication. You must start the treatment as soon as possible after you’ve been exposed to HIV, ideally within a few hours. The medicines must be taken every day for four weeks.
PEP is unlikely to work if it’s started after 72 hours (three days) and it won’t usually be prescribed after this time.
PEP makes infection with HIV less likely. However, it’s not a cure for HIV and it doesn’t work in all cases. Some strains of HIV aren't affected by the medicines.
Also, the treatment may not work if you:
take the medicines incorrectly
don't start taking the medicines soon enough

What are the side effects of PEP?
PEP can have severe side effects, such as:
prolonged headaches
If you’re already HIV-positive, but don’t know it, you could develop drug resistance to PEP if you don’t take your doses properly. This could limit your treatment options in the future.

Where can I get PEP?
PEP is only available on prescription. You can get PEP from:
a sexual health or genitourinary medicine (GUM) clinic
an A&E department of a hospital
However, PEP may not be available in all areas of England. GPs can't usually prescribe PEP.
Find your nearest GUM clinic
Find your nearest A&E department
When you request to have PEP, you’ll be asked some questions, such as:
who you had sex with, to assess your risk of exposure to HIV
whether you had oral, vaginal or anal sex
whether the other person definitely had HIV – and if known, what was their "viral load"

PEP and HIV tests
You’ll be asked to take an HIV test before starting PEP treatment, to check whether you already have HIV. If you don’t agree to an HIV test, you won't be given PEP.
You’ll also need an HIV test after the treatment, to check that it’s been successful.

Safe sex
HIV can’t be cured. Don't rely on PEP to prevent HIV, because it doesn’t always work.
Using a condom is the best way to prevent the spread of sexually transmitted infections (STIs), including HIV.