Tuesday, October 4, 2022

Post Exposure Prophylaxis Treatment For Hiv

What Happens When Im On Pep

Post-exposure prophylaxis (PEP), with Dr. Bertrand Lebouché

PEP isnt just a one-time pill its a regimen where you take many pills over many weeks. If your nurse or doctor gives you PEP, youll need to take medicine 1-2 times a day for at least 28 days . Its important that you take every pill as directed and dont skip doses, otherwise PEP may not work as well.

PEP isnt 100% effective, and it won’t prevent future HIV infections like PrEP can. So its important to keep protecting yourself and others from HIV while youre on PEP. Use condoms every time you have sex. If you inject drugs, dont share needles or works. This helps protect you from being exposed to HIV again. And it lowers the chances of giving HIV to others if you do have it

If you develop symptoms like a fever or rash while using PEP, talk with your doctor. These may be signs of the beginning stages of HIV.

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.

Criteria For Safe Discharge Home

  • Follow-up information for the patient is provided in the 5-day PEP starter kit.
  • Instruct patient to follow up with primary care provider who will consult the BC Centre for Excellence in HIV/AIDS to evaluate need for full 28-day course of PEP, before finishing the 5-day kit.
  • Patients seen at St. Pauls Hospital ED who receive PEP following a consensual exposure should contact St. Pauls Hospital IDC Clinic before finishing the 5-day kit.
  • For questions or concerns, patients can call the BC Centre for Excellence in HIV/AIDS at 1-888-511-6222.

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What Is Postexposure Prophylaxis

PEP is taken in emergency situations when exposure to HIV may have occurred. When taken as directed, its effective at preventing HIV transmission. Some examples of situations where PEP may be used include after:

  • engaging in consensual sex, especially without a condom or other barrier method or if a barrier method breaks
  • sharing needles or other injection drug equipment
  • having an occupational injury, such as a needlestick or a cut

Its important to note that PEP is for emergency use only. Its not a substitute for other HIV prevention methods, such as using a condom or other barrier method during sex or taking preexposure prophylaxis .

PEP is actually a combination of different antiretroviral drugs. These drugs work to prevent the virus from replicating effectively in the body. The combinations for most healthy adults and adolescents include:

  • tenofovir/emtricitabine with raltegravir
  • tenofovir/emtricitabine with dolutegravir

Guidelines For Pep Regimens

Post Exposure Prophylaxis, Occupational Exposure

Adults and adolescents

In the absence of randomized controlled trials, PEP guidelines are recommended based on drug combinations that have been effective in suppressing viral replication , are tolerated well, and have sufficient completion rates of these drugs as PEP . These particular regimens almost always consist of a dual nucleoside reverse transcriptase inhibitor backbone plus an integrase strand transfer inhibitor , a protease inhibitor , or a non-nucleoside reverse transcriptase inhibitor .

Currently, the Canadian guidelines for adults and adolescents recommend an oral dose of TDF/FTC once daily plus either RAL twice daily, DTG once daily, or DRV/r once daily as a preferred first-line regimen . Alternate regimens are also provided .

Guidelines from the U.S. also recommend a preferred first-line regimen for adults and adolescents with normal renal function of oral dose of TDF/FTC once daily plus either RAL twice daily or DTG once daily .

Children and infants

For children two years or older, Canadian guidelines recommend TDF plus 3TC once daily and RAL twice daily for 28 days as a preferred first-line regimen. Exact dosages of these drugs are dependent on bodyweight .

Conversely, WHO recommends ZDV/3TC as the preferred backbone regimen for children 10 years and younger in combination with LPV/r . TDF plus 3TC or FTC is provided as an alternative regimen for children three years or older, however concerns regarding potential bone toxicity are cited .

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What May Limit The Effectiveness Of Pep

PEP is typically very effective at preventing HIV transmission when taken exactly as directed. PEP is less effective when:

  • waiting more than 72 hours to start PEP after a potential exposure
  • not sticking with the treatment plan
  • engaging in behaviors that increase risk of HIV transmission
  • exposure to a strain of HIV thats resistant to the drugs in PEP

$597 to $1,000 without insurance. However, most insurance providers will cover PEP.

In some cases, an individual may not need to pay for PEP. For example, if a healthcare professional is exposed to HIV at work, their workplace insurance plan or workers compensation program typically pays for PEP.

In cases of sexual assault, the cost of PEP may be partially or completely covered. Survivors can reach out to the Office for Victims of Crime to learn about options in their state.

What Are The Other Possible Side Effects Of Truvada For Prep

Serious side effects of TRUVADA may also include:

  • Kidneyproblems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys before and during treatment with TRUVADA. If you develop kidney problems, your healthcare provider may tell you to stop taking TRUVADA.
  • Too much lactic acid in your blood , which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.
  • Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.
  • Bone problems, including bone pain, softening, or thinning, which may lead to fractures. Your healthcare provider may do tests to check your bones.

Common side effects in people taking TRUVADA for PrEP are headache, stomach-area pain, and decreased weight. Tell your healthcare provider if you have any side effects that bother you or do not go away.

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Who Might Need Pep

  • People who think they might have been exposed to HIV during sex
  • People who have been sexually assaulted
  • Drug users who recently shared needles or other related items
  • Health care workers who think they’ve been exposed to HIV on the job

If you think you were exposed to HIV, go to the hospital or see your doctor as soon as possible. They can help you figure out whether you need PEP.

Key Factors Implicated In The Efficacy Of Pep

Does this Patient Need HIV Post-Exposure Prophylaxis (PEP)

There is a wide-scale lack of knowledge about PEP among health care providers and research regarding implementation and supporting awareness of PEP is greatly needed .

The timing of initiation and the duration of treatment are crucial to the success of PEP . Ensuring the timely and appropriate prescription of PEP, and understanding barriers to access, remain a challenge . Maintaining sufficient antiretroviral drug levels is also important in preventing replication of the HIV virus . Adherence to the prescribed regimen is therefore a determinant in the effectiveness of PEP . Adherence and completion rates of PEP are generally low in most settings as adherence can be impacted by side effects that can impact individuals physically and psychologically . As a result, it is important that research continues to determine tolerable and convenient antiretroviral drug regimens in addition to investigating adherence interventions .

In the absence of randomized controlled trials, monitoring individual and population-level outcomes will provide vital information regarding the effectiveness of PEP delivery and follow-up, adverse effects, and PEP failure . The World Health Organization Guideline Development Group has recommended a global PEP registry be established . This would provide information regarding follow-up and linkage to care and inform future recommendations for PEP drug regimens .

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What Should I Tell My Healthcare Provider Before Taking Truvada For Prep

  • All your health problems. Be sure to tell your healthcare provider if you have or have had any kidney, bone, or liver problems, including hepatitis.
  • If you are pregnant or plan to become pregnant. It is not known if TRUVADA can harm your unborn baby. If you become pregnant while taking TRUVADA for PrEP, tell your healthcare provider.
  • If you are breastfeeding or plan to breastfeed. Do not breastfeed if you think you may have recently become infected with HIV. HIV can be passed to the baby in breast milk. Talk to your healthcare provider about the risks and benefits of breastfeeding while taking TRUVADA for PrEP.
  • All the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. TRUVADA may interact with other medicines. Keep a list of all your medicines and show it to your healthcare provider and pharmacist when you get a new medicine.
  • If you take certain other medicines with TRUVADA, your healthcare provider may need to check you more often or change your dose. These medicines include certain medicines to treat hepatitis B or C infection.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.FDA.gov/medwatch, or call .1-800-FDA-1088.

Timely Answers For Urgent Exposure Management

Get rapid, expert guidance in managing healthcare worker exposures to HIV and hepatitis B and C, including recommendations on when and how to initiate PEP through our online Quick Guide for urgent occupational PEP decision-making, or from experienced clinicians on our telephone consultation service. Note that our hours have changed because of funding limitations. We cannot accept calls from unknown numbers. Please unblock your phone prior to calling the PEPline.

Alert: Some calls to the PEPline using a Cisco phone may not go through. Please use another phone or cell phone. We are addressing this issue.

Hours of operation for occupational PEP consultation are 11 a.m. 8 p.m. ET . If you are trying to reach us regarding an occupational PEP question outside of these hours, please check out our PEP Quick Guide for Occupational Exposures.

Hours of operation for non-occupational PEP consultation are 9 a.m. 8 p.m. ET Monday Friday, and 11 a.m. 8 p.m. ET on weekends & holidays.

448-4911

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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 don’t 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.

Advice From National Experts In Exposure Management And Care

HIV Pre Exposure Prophylaxis

The NCCCs consultation on exposure management has helped guide PEP decision-making for more than 15 years: 150,000 PEP consultations have been provided in the NCCCs history. Members of our clinical consultation staff, which includes Infectious Disease specialists, family physicians, clinical pharmacists, and nurses, have participated in establishing federal PEP Guidelines and treatment recommendations. Advice is based on established Guidelines and the latest medical literature.

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How Well Does Prep Work

PrEP is very effective when you take it every day. It reduces the risk of getting HIV from sex by more than 90%. In people who inject drugs, it reduces the risk of HIV by more than 70%. PrEP is much less effective if you do not take it consistently.

PrEP does not protect against other STDs, so you should still use latex condoms every time you have sex. If your or your partner is allergic to latex, you can use polyurethane condoms.

You must have an HIV test every 3 months while taking PrEP, so you’ll have regular follow-up visits with your health care provider. If you are having trouble taking PrEP every day or if you want to stop taking PrEP, talk to your health care provider.

How To Pay For Pep

Use the resources below to get help paying for PEP:

  • Patient assistance programs. Many pharmaceutical companies have patient assistance programs that offer low-cost or no-cost medications to eligible individuals. Some to check out are:
  • Gilead Advancing Access.Advancing Access is the patient assistance program from the producer of Truvada.
  • Merck. Merck has patient assistance programs for many of their drugs, including Isentress.
  • ViiV Connect.ViiV Connect is the patient assistance program from ViiV Healthcare, the maker of Tivicay.
  • Medicine Assistance Tool. The Medication Assistance Tool helps people find programs that can help them get prescriptions at low cost or no cost. Enter the relevant medications and some basic personal information to get started.
  • Medicaid.Medicaid is a joint federal and state program that helps to cover healthcare costs for people with low income and resources. Coverage and eligibility can vary .
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    Where To Get Pep

    PEP is available on the NHS for free, but is only given to people who meet guidelines about its use.

    The best place to get PEP is a sexual health or HIV clinic. If you need PEP over the weekend or outside of office hours, when clinics will often be closed, the best place to go is an Accident and Emergency department.

    PEP is not normally available from GPs.

    As PEP is a powerful course of drugs, and is expensive to prescribe, you might be asked about:

    • the person you had sex with
    • what sort of sex you had
    • if the other person had HIV, what their viral load is.

    If the person you had sex with is living with HIV and has an undetectable viral load, you will not need PEP as it wont be possible for the virus to have been transmitted.

    Once a doctor decides that its appropriate for you to have PEP, you will be asked to take an HIV test. This is to make sure you dont already have HIV. If HIV is detected by a test, other forms of treatment will be recommended to you.

    Exposure To Hiv Is A Medical Emergency

    Non-occupational HIV Post Exposure Prophylaxis (nPEP)

    If you think you were exposed to HIV, talk to a medical professional about PEP as soon as possible. You can:

  • Outside NYC: 844-PEP4NOW
  • In NYC: 844-3-PEPNYC
  • Talk with your primary care provider right away and ask if they can provide PEP.
  • Go to the local emergency room right away. The “What is PEP” fact sheet has information about PEP and what to expect when you go for a PEP evaluation. Print this fact sheet and bring it with you to the emergency room.
  • PEP provides emergency protection after a possible exposure to HIV, but you must act quickly. After a possible exposure to HIV, you may be able to stop the infection by taking medications. Do not delay. PEP needs to be taken as soon as possible after you may have been exposed. PEP is less likely to work when taken more than 72 hours after exposure. For more information about PEP see:

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    How Much Does Pep Cost How Can I Pay For It

    PEP is covered by Medicaid and most private insurance plans. Co-pay assistance is available, and many patients with insurance pay nothing out of pocket. If you need help or do not have insurance, ask about patient assistance programs which may pay for the full cost of the medication.

    If you are seeking PEP following an experience of sexual assault, you may visit any emergency room in Illinois to receive state mandated free care including PEP, emergency contraception, and STI testing.

    The Illinois Rape Crisis Hotline can be reached at 888.293.2080.

    What Is Involved In Taking Pep

    First, a doctor or nurse will assess whether the risk of HIV transmission is high or low, using the risk assessment described above. If the risk is high enough, PEP will be prescribed.

    PEP should only be used by people who are HIV negative. When a person starts PEP, an HIV test must be done to determine their HIV status. If the person is HIV positive they should be referred to HIV care and treatment.

    If rapid HIV testing is not available, the test result may not be ready for one to two weeks however, PEP will be started immediately. PEP should be discontinued if the PEP user tests HIV positive, or if the contact person is confirmed to be HIV negative.

    PEP medications need to be taken consistently and correctlyevery day for four weeksor the risk of HIV infection will increase. A counsellor, doctor, nurse, pharmacist or staff member at an AIDS Service Organization can suggest strategies to help a person adhere to the pill-taking schedule and/or manage any side effects of the drugs.

    A person taking PEP needs monitoring for side effects and other complications such as drug toxicity, though this is rare. Blood tests may be needed to ensure that the medications are not causing harm to the body. If side effects and toxicity are a problem, a doctor may decide to change one or more of the drugs being used for PEP.

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