Preventing Hiv Infection After Exposure

What Are Prep And Pep

PrEP and PEP are medicines to prevent HIV. Each type is used in a different situation:

• PrEP stands for pre-exposure prophylaxis. It is for people who dont already have HIV but are at very high risk of getting it. PrEP is daily medicine that can reduce this risk. With PrEP, if you do get exposed to HIV, the medicine can stop HIV from taking hold and spreading throughout your body.
• PEP stands for post-exposure prophylaxis. PEP is for people who have possibly been exposed to HIV. It is only for emergency situations. PEP must be started within 72 hours after a possible exposure to HIV.

Who Should Be Offered Pre

The risk of HIV acquisition depends on the likelihood that the contact person has transmissible HIV infection and on the exposure type . Several studies have shown that a person who is HIV positive, is receiving antiretroviral therapy, and has a viral load of less than 200 copies/mL cannot transmit HIV to sexual partners.2022 The indication for PrEP is based on the likelihood of high-risk exposure to transmissible HIV.6

Risk of HIV transmission by exposure6

Risk that a person has transmissible HIV infection

Substantial

• HIV positive with viral load > 40 copies/mL

• HIV status unknown but from a population with high HIV prevalence

Low but nonzero

• HIV positive with viral load < 40 copies/mL with concomitant sexually transmitted infection present at time of exposure

Negligible or none

• Confirmed HIV negative

• HIV positive with confirmed viral load < 40 copies/mL and no sexually transmitted infection at time of exposure

• HIV status unknown, general population

Risk of HIV transmission by exposure type from HIV-positive source

High

• Sharing sex toys

• Blood on compromised skin

Pre-exposure prophylaxis algorithm, based on the CDC guideline.6 Note: CDC = Centers for Disease Control and Prevention, GBM = gay, bisexual and men who have sex with men, GC = gonorrhea, STI = sexually transmitted infection.

How Does Pep Work

The same drugs that treat HIV can fight the virus as it tries to infect you. These medications are called antiretrovirals.

PEP is a combination of three drugs. You take them once or twice a day for 28 days:

• For adults, the CDC recommends tenofovir, emtricitabine , and a third drug, either raltegravir or dolutegravir.
• Women who are in early pregnancy, who are sexually active and could become pregnant while taking PEP, or who were sexually assaulted without birth control should take raltegravir rather than dolutegravir because of a risk of birth defects.
• Children 2 or older who need PEP usually get the same drugs in different doses.

Your doctor will take a sample of your blood when you start PEP and may want to test for other sexually transmitted diseases. Youâll need HIV tests after youâre through with PEP to make sure you didnât get the virus.

If youre on PEP, use condoms when you have sex to lower the chances that youll come into contact with HIV again or, if you have the virus, that youll spread it.

If PEP doesnât work and you get HIV, it might be because the virus resists some of the medications.

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Paying For Pep For Another Reason

• If you cannot get insurance coverage, your health care provider can apply for free PEP medicines through the medication assistance programs run by the manufacturers.
• These requests for assistance can be handled urgently in many cases to avoid a delay in getting medicine.

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Efficacy And Safety Of Pep

The use of zidovudine after occupational exposure to HIV was associated with a 79% reduction in the odds of HIV transmission in the Centers of Disease Control and Prevention study. Further evidence to support the use of PEP comes from the use of AZT in prevention of perinatal transmission. AZT given to pregnant women orally starting at between 14 and 34 weeks, then intravenously during delivery and orally to the neonate for six weeks reduced vertical transmission rates at age 18 months from 25.5% to 8% when compared with placebo. Recent placebo controlled trials showed that short courses of AZT reduced the risk of transmission of HIV to the baby at 36 months by about 3750%. Current UK guidelines now recommend starting AZT in the third trimester to prevent vertical transmission.

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When Is Pep Used

PEP can be used after exposure to HIV in a work context or after exposure to HIV that is not work related such as sexual exposure or injection drug use .

Occupational PEP is when PEP is used by people who have an exposure to blood and/or body fluids that may contain HIV in their workplace for example, a healthcare worker who accidently experiences a needle-stick injury.

Non-occupational PEP is when PEP is used after a potential high-risk exposure to HIV that is not work related, such as unprotected sex, a condom breaking during sex, sexual assault, or sharing needles used to inject drugs.

How Can I Prevent Hiv If I Inject Drugs

Intravenous drug users who share needles are at high risk for HIV. Sharing needles can place another person’s blood right into your body, even if the amount is so small that you can’t see it on the needle.

People who inject steroids, insulin, or medicines for other health problems are at risk for HIV if they do not use sterilized needles every time. Whenever you need to use a needle, be sure that it is sterilized. Do not share needles with anyone. You can also get HIV if the equipment used for body piercings and tattoos is not sterilized.

If you inject drugs or medicines, follow these steps to lower your risk of getting HIV:

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How Long Does Prep Take To Protect A Person From Hiv Exposure

For the receptive partner in vaginal intercourse, it takes approximately 20 days of taking the medication consistently to reach the level of full protection in the female genital tract. This is why cis-gender women and transgender men who have receptive vaginal intercourse should not take on-demand PrEP. People of transgender experience should talk with their healthcare provider about their specific sexual practices to best determine the length of time it will take to be fully protected.

How Do I Access Prep

PrEP was listed on the Pharmaceutical Benefits Scheme from 1 April 2018.TheAustralian Government subsidises the cost of the PrEP, making it more affordable for people who need it.

All GPs in Australia can prescribe PrEP. If you have a Medicare card, it can be purchased at a subsidised cost from all retail pharmacies, with a valid prescription.

If you do not have a Medicare card, or cannot afford the subsidised cost, PrEP can be imported through online pharmacies. More information is available from PAN or the Victorian PrEP Service at the Alfred Hospital on .

If your doctor is unfamiliar with PrEP or whats involved in prescribing it, they can call the Victorian PrEP Service at Alfred Hospital, on .

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What Proportion Of Eligible Patients In Canada Are Taking Pre

National surveillance of PrEP use in Canada is not undertaken, which makes patterns of use difficult to quantify. However, use is likely increasing. Pre-exposure prophylaxis was used off label until Health Canada approved daily TDF/FTC for PrEP in 2016, lower-cost generic versions became available in 2017 and the Canadian guideline was released in 2017.2,6,32

A study of prescription data in 8 provinces estimated that 9657 patients were receiving PrEP in 2018, about 98% of whom identified as male.32 Between 2017 and 2019, eligibility for PrEP by Canadian guidelines for GBM in major urban centres ranged from 44.9% to 58.1%, yet only 14.5%21.8% had used PrEP.3 Even among GBM at elevated risk of HIV, only 24.6% were taking PrEP in 2017.4

In 2018, women made up 25% of new HIV diagnoses yet accounted for only 2% of PrEP users in Canada.1,32 Minimal data on uptake in other populations are available.

Practical Management Of The Victim

Despite the lack of data on PEP in sexual exposure/assault, PEP should be offered to the sexual assault victim once the clinician has assessed all the factors involved in the likelihood of HIV transmission. PEP should be viewed in the overall context of the physical and psychological trauma of the rape victim PEP might help the victim gain a sense of control and decrease their anxiety about acquiring HIV. The patient should be reassured that the risk of transmission is small, may increase with certain risk factors, and PEP may or may not be indicated in their case. The patient should be informed of its questionable efficacy and that until further studies are carried out, our knowledge of PEP is largely based on PEP in occupational exposure.

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Does Prep Have Any Side Effects

Most people who take PrEP dont experience side effects. Others may have some mild effects like nausea, loss of appetite and headaches. These usually disappear within the first month.

A small proportion of people taking PrEP may develop kidney damage, so it is very important to have kidney tests every 6 months when you are taking PrEP.If you have any concerns about side effects, see your doctor.

Find Out If You Need Pep

Take our online risk assessment to find out whether you’ve been at risk and whether its suitable for you to take PEP.

You can also call THT Direct on 0808 802 1221.

If you’re worried that you’ve been exposed to HIV, it might be well worth finding out more about HIV prevention pill PrEP . It’s available in some form in all UK countries and when taken as prescribed is almost 100% effective at preventing HIV transmission.

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Can I Take Medicine To Prevent Getting Or Passing Hiv

Yes. Several medicines are available to help lower your risk of getting or passing HIV:

Pre-exposure prophylaxis

PrEP is an HIV prevention method for people who do not have HIV infection but who may be at high risk. PrEP is a pill you take by mouth every day.

Talk to your doctor about PrEP if:

• You are HIV-negative but your partner is HIV-positive
• You are not in a monogamous relationship and you do not always use condoms
• You inject illegal drugs or share needles
• You have a partner who is HIV-positive, and you want to get pregnant. PrEP may help protect you and your baby.

The Centers for Disease Control and Prevention estimates that PrEP could prevent transmission in as many as 140,000 serodiscordant heterosexual couples.4Learn more about PrEP.

Post-exposure prophylaxis

PEP is an anti-HIV medicine for people who may have been very recently exposed to HIV.5 If you think you have been exposed , or if you were sexually assaulted, talk to your doctor or nurse about taking PEP.

You must take PEP within three days of exposure to help lower your risk for HIV. You then take two to three antiretroviral medicines for 28 days to prevent the virus from copying itself and spreading through your body.

While taking PEP, you still need to take steps to prevent HIV, including using a condom with sex partners. Learn more about PEP.

Antiretroviral medicines

What Hiv Medicines Are Used For Pep

The Centers for Disease Control and Prevention provides guidelines on recommended HIV medicines for PEP. The CDC guidelines include recommendations for specific groups of people, including adults and adolescents, children, pregnant women, and people with kidney problems. The most recent PEP recommendations can be found on CDCs PEP resources webpage.

Your health care provider or emergency room doctor will work with you to determine which medicines to take for PEP.

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Putting A Number On It: The Risk From An Exposure To Hiv

This information was provided by CATIE . For more information, contact CATIE at 1-800-263-1638.

Author: James Wilton

Service providers working in HIV prevention are often asked by their patients and clients about the risk of HIV transmission from an exposure to HIV through sex. What do the latest studies tell us about this risk? And how should we interpret and communicate the results?

Visit Your Doctor Every 3 Months

It is recommended to see your doctor every 3 months for repeat HIV and STI tests and for a new PrEP prescription.

PrEP can have some side effects, so work with your doctor to monitor your general health.

PrEP does not provide protection against other STIs

Condoms and lubricant can provide protection against and reduce the risk of spreading a STI.

It is important to have a sexual health test every 3 months while on PrEP, even if you have no symptoms.

To find out about more about PrEP, how to access it and the costs, visit PrEP Access Now.

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Other Things To Consider

It is best not to rely on PEP as a regular way of preventing HIV if you are having condomless sex or sharing drug injecting equipment. Condoms, when used properly, are an effective way of preventing HIV and most other sexually transmitted infections . PEP wont stop you getting other STIs while youre taking it, so its sensible to use condoms during that period as well. Staff at sexual health clinics can provide information and advice about sexual health and how best to protect yourself from HIV and other STIs.

Guidelines have set out the range of activities where risk of HIV is great enough that PEP is recommended.

If you have needed PEP more than once in the past, you might want to consider taking PrEP . A doctor or nurse at a sexual health clinic can help you think through whether you need PrEP and whether it is suitable for you. This will involve being asked about the type of sex you have been having and expect to have in the future.

Taking PEP at the same time as other drugs can produce drug interactions. When accessing PEP it is important to tell the doctor or pharmacist about any other medicines you take. This includes over-the-counter medication, vitamins/minerals, herbal remedies and recreational drugs. That way, you can avoid interactions that can result in serious side effects or drugs being ineffective.

If you are breastfeeding, you can still take PEP. Doctors will choose a regimen that is suitable for you and your baby and offer appropriate advice.

Can I Take Pep Every Time I Have Unprotected Sex

PEP is only for emergency situations. It is not the right choice for people who may be exposed to HIV frequently – for example, if you often have sex without a condom with a partner who is HIV-positive. In that case, you should talk to your health care provider about whether PrEP would be right for you.

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I’m Pregnant And Have Hiv Will My Baby Get Hiv

If you are getting treatment for HIV, the answer is most likely no. When HIV medicine is used consistently and correctly, a pregnant woman living with HIV who is treated for HIV early in her pregnancy can lower the risk of delivering a baby with HIV to less than 1%. Without treatment, this risk is about 25% in the United States.6

All women need to be tested for HIV during their first prenatal care visit, early in the pregnancy. High-risk women who get a negative HIV test result should be tested again later in pregnancy.

Treatment, called antiretroviral therapy, works best when it is:

• Started as early as possible in pregnancy
• Also given during labor and delivery
• Given to the infant after birth

If you are HIV-positive and your viral load is greater than 1,000 copies per milliliter, your doctor may recommend delivering your baby by cesarean .

Rationale For Pep And Evidence Of Pep Effectiveness

Lead author: Elliot DeHaan, MD, with the Medical Care Criteria Committee November 2021PEP in children material: Aracelis Fernandez, MD, with Lisa-Gaye Robinson, MD, and Ruby Fayorsey, MD

Post-exposure prophylaxis has been established to effectively prevent HIV infection in an exposed individual when initiated within 2 hours and no later than 72 hours after an exposure. Rapid and effective response to a reported HIV exposure are key to the successful prevention of HIV infection.

PEP blocks viral replication: After percutaneous or mucosal exposure to HIV, local replication of virus occurs in tissue macrophages or dendritic cells . However, if infection cannot be contained at this stage, it is followed within 48 to 72 hours by replication of HIV in regional lymph nodes. Viremia then follows within 72 to 120 hours of virus inoculation.

This sequence of events carries significant implications. Given the rapid appearance of productively-infected cells following the introduction of virus, PEP regimens with the most rapid onset of activity, multiple sites of antiviral action, and greatest potency are likely most effective.

Evidence of PEP effectiveness: Evidence of PEP effectiveness has been derived primarily from animal model studies and extrapolated from clinical trials of ARV prophylaxis to prevent perinatal transmission of HIV.

Evidence from human studies: A limited number of case-control studies and clinical trials have established PEP effectiveness in humans.

References

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