HIV Post Exposure Prophylaxis (HIV PEP) is a medicine that it taken after a significant exposure to HIV to reduce the risk of a chronic HIV infection. Think of is as a morning after pill for HIV. It was initially developed for health care workers who suffered from needlestick injuries from HIV contaminated needles. However, now it is also commonly used for sexual exposures to HIV.
What exactly is HIV PEP?
It is a medicine taken for 1 month following a significant HIV exposure that can reduce the risk of a chronic HIV infection. Current guidelines published on HIV PEP recommend different medications. Your Doctor should be able to advise you on what is right for you.
HIV PEP must be started within 72 hours of exposure. There is not data to show that taking HIV PEP is effective if taken after 72 hours from the exposure.
Who needs to take HIV PEP?
The simple answer is anyone who has had a significant exposure to HIV. Unfortunately this is not as simple as it seems. As there is no one single definition of “significant exposure”. So for sexual exposures, the decision whether or not to take HIV PEP is a joint decision made by both the patient and physician after an objective discussion of the risks. For a detailed discussion on the risk of getting HIV, click on this link to my other article.
That said here are a few pointers from current guidelines:
- HIV PEP is recommended following:
- Receptive anal intercourse with a partner with unknown HIV status or is HIV positive with an unknown or detectable viral load.
- Receptive vaginal intercourse with a partner who is HIV positive with an unknown or detectable viral load.
- Sharing needles with a partner who is known to be HIV positive with an unknown or detectable viral load.
- HIV PEP is considered following:
- Insertive anal intercourse with a partner with unknown HIV status or is HIV positive with an unknown or detectable viral load.
- Insertive vaginal intercourse with a partner who is HIV positive with an unknown or detectable viral load.
- HIV PEP is generally not recommended:
- If the source is HIV positive but has been on treatment for at least 6 months and has an undetectable viral load.
- Sharps and splash injuries, sharing needles, receptive vaginal intercourse with a partner of unknown HIV status.
- Human bite is the source is HIV positive with an unknown or detectable viral load.
How effective is HIV PEP?
We do not actually know because there is very little good quality data on the use of PEP in “non-occupational” settings. In an observational study on the use of HIV PEP in health care workers who were pricked by a HIV contaminated needle, HIV PEP was found to reduce the risk of getting HIV by 81% (95% Confidence Interval 48% to 94%). There are also a number of other case reports and observational studies on various population groups such as Victims of Sexual Assault, Men who have sex with Men and general population studies. Without going into too much statistical detail, HIV PEP was found to be effective but not 100% foolproof.
What can I expect from my visit to the Doctor?
First the Doctor will ensure that your exposure was within the last 72 hours. Once 72 hours have past, HIV PEP is no longer effective.
Next your Doctor will have a discussion with you on your HIV risk and determine if you will benefit from HIV PEP or not. Click here for my article on HIV risks.
Prior to dispensing the medicines, some blood tests have to be done. These usually include a full blood count, liver function tests and kidney function tests. Also a rapid HIV test to ensure that there is no established HIV infection. Note that this HIV test is not to determine if you were infected with HIV < 72 hours ago. It is to document that you do not already have an established HIV infection. Because if you do, then there is no need to take HIV PEP. Click here on my article on the Accuracy of HIV tests. If you have had these tests done recently, you should bring it along for your Doctor’s visit. The Doctor may be able to accept the reports and not have to repeat the tests for you.
Once you and your Doctor agrees on starting in HIV PEP, the medicines will be dispensed to you.
How do I take HIV PEP medicines and what are the side effects?
Most HIV PEP medicines these days only consists of 1 pill a day. Although some regimes require you to take up to 3 pills a day. You should take the pills at the same time every day. Set the alarm on your smartphone to remind you if you have to. You should also never forget or skip your pills. Make sure you complete the entire course.
Different pills have different side effects. For the newer pills, most patients do not even get side effects. For the older pills, some patients get significant nausea and diarrhea. Very rarely, some people may develop a rash.
HIV PEP pills must be used with care in people who carry the Hepatitis B virus. If you are a Hepatitis B carrier please do inform your Doctor. You will need to be closely followed up and some extra tests need to be done. This is because there is a small risk of a flare up of the Hepatitis B once the HIV PEP medicines are stopped.
What happens after I finish my HIV PEP pills?
Your Doctor will arrange for you to see him again after you have completed your pills. He will likely recommend a repeat of your full blood count, liver function tests and kidney function tests. And of course your HIV test. He may also recommend screening for the other STDs like Syphilis, Hepatitis, Chlamydia and Gonorrhea.
Your Doctor may also need you to go back for a return visit in 3 months.
If during this time you experience symptoms that can suggest an acute HIV infection, you should go back to see your Doctor. Click here for my article on Early Symptoms of HIV Infection.
Also, if you experience symptoms that may suggest an STD (i.e. pain passing urine or a penile or vaginal discharge) you should also go back to see your Doctor.
What is the cost of HIV PEP?
HIV PEP medications can be very costly. Here is Singapore the cost of HIV PEP Medication at our Men’s Health Clinic is S$900. With consultation, blood tests and taxes, the total cost ranges between S$1,000 to S$1,300. Of course costs will vary depending on your location and provider.
So what do I do now?
If you have had a significant exposure to HIV less than 72 hours ago, contact your Doctor urgently. Have a frank discussion with your Doctor about your risks and whether or not HIV PEP is right for you.
Have a question on HIV PEP? Please put it in the comments section below.