Post-Exposure Prophylaxis for HIV (PEP)

Introduction

The use of post-exposure prophylaxis (PEP) to prevent HIV infection dates back to the early 1990s, when chronic infection treatment options were limited. Prophylaxis was mostly utilized in response to occupational hazards. 1

According to a case–control research published in 1997, health care professionals who received zidovudine following needles tick exposures were 81 percent less likely to develop HIV seroconversion.

Combination medications are now commonly provided, therefore contemporary HIV PEP may be more effective. PEP, on the other hand, is not a guarantee of safety.

Antiretroviral medication may be used to prevent infection after being exposed to HIV through sexual contact or injecting drug use. Although no efficacy statistics are available for this method, it has gained universal acceptability due to extensive safety and feasibility evidence.

General principles

• Only patients who present within 72 hours after a significant exposure from a known HIV positive individual or a suspected high-risk source should be considered for HIV PEP. The initial dose of PEP should be administered as soon as feasible, preferably within 2 hours.
• PEP should not be offered if the source has tested negative for HIV or if the risk assessment has determined that the source is unlikely to contract HIV.
• If the source's HIV status is unclear, a thorough risk assessment should be conducted. In the vast majority of such exposures, PEP is unlikely to be justified.

Risk assessment

The risk of an individual contracting HIV as a result of an exposure is determined by the likelihood that the source is HIV-positive if the source is unknown, as well as the risk of infection as a result of a specific exposure from an HIV-positive individual.

Risk of HIV transmission = risk of infection x risk of exposure (including co-factors such sexually transmitted illnesses, high HIV viral load, and bleeding).

Calculating the likelihood that the source is HIV positive

If a considerable exposure occurs, every effort should be taken to determine the source's HIV status.

·         The source has tested negative for HIV - if the source has had a recent HIV negative test within the last three months and there is no clinical sign of a retroviral/ seroconversion-like disease, and the source is not deemed to be at high risk of infection

·         If the source has a positive HIV test, a physician has diagnosed HIV, or the source self-reports an HIV diagnosis, they are deemed HIV positive. A low or undetectable HIV viral load reduces the risk of transmission but does not completely remove it. If the source is taking anti-HIV treatment, PEP should be reviewed with the treating ID expert. Start normal PEP if you can't get in touch.

Counseling

1. If the recipient's HIV risk is high and PEP is being considered, he or she should be counseled on the risks and benefits of PEP. Counseling should include
2. ·         The HIV risk estimate
3. ·         The danger of HIV infection must be weighed against the potential for major side effects from PEP.
4. ·         The possibility of having to notify the insurer of a positive test result, whether for an existing policy or a new application.
5. ·         Early detection vs. the consequences of a favorable outcome
6. ·         The window of opportunity

 Key points

·         Only consider PEP if the exposure occurred within 72 hours.

·         The initial dose of PEP should be administered as soon as feasible, preferably within 2 hours.

·         Assess risk depending on the type of exposure and what is known about the source (also consider HBV and HCV risk – see appendices)

·         If possible, test the source.

·         If you're not sure what to do, talk to a senior emergency medicine doctor or an HIV specialist.

·         If PEP indicated

1.       Counsel

2.      Test blood and urine

3.      Prescribe starter pack

4.      Arrange follow up at ID or GUM clinic before starter pack runs out

5.      Advise no unprotected sex for 3 months

·         Fill out the patient management form (appendix 1) to use as a checklist.

 

Where is PEP Available?

HIV drugs are available all over India. But Delhi's HIV Specialist Dr. Vinod Raina is available 24*7 in Safe Hands Multispecialty STD clinic. Dr. Vinod Raina is a well-known Dr. for PEP treatment in Delhi.

How to Reach Dr. Raina’s Safe Hands Multispecialty STD clinic

India's famous Dr. Vinod Raina has been in the post of CMO in Delhi's Safdarjung Hospital, he has been treating patients suffering from HIV for the last 22 years. You should get PEP treatment in Delhi

To reach Dr. Vinod Raina, you can contact him on WhatsApp on his number +91-9136363692. You can also contact him on his email address & our official website:

https://www.pepforhivtreatment.com/

Call us 9136363692, 9871605858

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