HIV is a retrovirus that is transmitted through sexual or through the contact of various bodily fluids. Thankfully, modern medicine has given us HIV PEP, or post-exposure prophylaxis, as treatment options for those who are recently exposed to the virus.
HIV PEP usually comes in the form of two drugs: Truvada or ritonavir. Together, these drugs work to prevent a viral infection. However, PEP is not a regular way to prevent HIV, HIV PReP should be used instead to prevent prior exposure. When used correctly, the risk of contracting HIV is reduced by more than 90%.
Although HIV PEP is effective at preventing HIV infection after exposure to HIV, it is not a “wonder pill”. It is a dosage of several drugs at varying times for at least a month, and can have uncomfortable side effects. PEP should primarily be used after accidental exposure to HIV within seventy two hours, if the exposure through workplace exposure, unsafe sexual activity, or needle sharing through intravenous drug use has occured. It is important to have proper precautions in place in order to prevent HIV exposure and prevent the spread of the virus.
HIV PEP has saved countless people from becoming infected with HIV, and these antiretroviral drugs are incredible examples of modern medicine and is paving the way for further HIV treatments.
What is HIV PEP?
HIV PEP (post-exposure prophylaxis) is an emergency drug used within 72 hours of possible exposure to HIV. Similar to the emergency contraceptive pill, PEP has the potential to stop the virus from occurring. HIV PEP can be administered no matter what type of exposure happened. HIV PEP is recommended after unprotected anal, vaginal, oral sex that had ended with exposure to semen, blood or other bodily fluids, as well as an accidental needle stick.
There are few drug interactions with PEP drugs, and while the side effects and having to take the medications for a minimum of 28 days can be overwhelming, it is still a small price to pay for not having an incurable disease.
PEP is available to anyone who has come in contact with the virus and has been tested to be HIV negative, but special consideration is taken into account for those who are breastfeeding and pregnant. As HIV is passed on from mother to child in some cases via breastfeeding and birth, it is essential that the infant and mother are protected from the virus. So far, PEP has not shown any issues regarding breastfeeding in %country% and is considered to be a safe alternative.
HIV PEP is most likely available at your local clinic in %country%, as most clinics will stock the medication. In lower-income areas, PEP may also be available for free.
PEP is also able to be taken more than once, and the worst thing that could occur would be the side effects that come along with the treatment. But if you are constantly being exposed to HIV, PEP may not be the best line of defense against HIV, and you may want to check out PReP as a daily drug to prevent HIV. PReP and PEP are similar, so if you can tolerate PEP you will be able to take PReP. Ask your doctor about taking PReP once you finish your course of PEP, so you can stay protected.
What are the side effects of HIV PEP?
Like every other drug on the market, there are potential side effects that may occur while taking the drug. Individual PEP drugs have differing side effects, the most common ones include nausea and a general feeling of being “under the weather” and lethargy. Other potential side effects include headaches, fatigue, vomiting, and diarrhoea. Gastrointestinal distress is possibly the most major group of side effects, but will pass once the course of the drug has been completed.
Besides feeling tired and other fairly mundane symptoms, it is not common to experience any serious or lasting side effects due to taking PEP. There is a possibility of liver damage, but the chances of having this occur is rare and does not occur in most patients. These side effects should not stop you from seeking treatment either, as HIV/AIDS is infinitely worse than having an upset stomach and a headache. While these side effects are uncomfortable and not wanted, it is still important that you do not miss a dose or put off a dose, as this will disrupt the treatment and render it ineffective. Of course, your doctor will explain to you these side effects and how likely there are to occur to you.
PEP and getting a script
Antiretroviral drugs are not a new concept – the efficacy of these drugs were proven in studies completed in the 1990s, with a human control study in 1997. The medical technology and understanding has changed in twenty years, and so has the efficacy, as these are more productive at counteracting the virus.
A healthcare provider located at sexual health clinics and accident and emergency departments will prescribe both Truvada (a NRTI), and raltegavir, which is an integrase inhibitor. In the instance there is an issue with either drug, your provider can switch you over to a less commonly provided drug, which are reserved for those who cannot take the two.
There is a criteria list that a healthcare provider will run through before prescribing the drug, and these criterium include:
- The person receiving treatment is HIV negative, a HIV test will be performed when you go to a GP for HIV PEP.
- The other person is HIV positive, or their status is unknown (ie: a one night stand after a few drinks).
- It’s less than 72 hours from exposure.
- There is a strong possibility that exposure may have happened.
These criterium help doctors identify if PEP is the right treatment plan for someone who is potentially infected, as one may think they came into contact with the virus but actually did not.
Timing is a key part of ensuring effectiveness. Taking PEP within the 72 hour window is a must, as it has been found in scientific studies that the greatest protection was achieved with a post-exposure of 2 hours. The twenty-eight day minimum for treatment has also prevented 100% of infections if given within 24 or 36 hours. The sooner your body can learn to fight off this retrovirus, the more likely it is to be able to ward off infection when present.
These drugs, Truvada and raltegavir, must be taken for a minimum of twenty eight days, or four weeks. Missing or mis-timing a dose will result in a decreased efficacy of the drug, and puts you at a higher risk of contracting the virus. In the instance that you are exposed to HIV once again during treatment, it will be necessary for you to take two extra days’ worth of treatment. These drugs are not a form of prevention; you need to consistently use condoms and take PReP if you are constantly being exposed to the virus.
In contrary to belief, you can consume alcohol while taking PEP. There have been no known interactions with alcohol or any major complications due to occasional marijuana usage during treatment, but alcohol may increase the effects of nausea, vomiting, and headaches. However, some common drugs will interact negatively with PEP, Truvada specifically. These drugs are commonly used, and include Advil, Aleve, and ibuprofen.
Medical testing of PEP
HIV PEP has been a topic of interest for many infectious disease researchers, which has lead to hundreds of research projects to be conducted. In a 2015 study published with the IDSA (Infectious Disease Society of America) along with HIVMA (HIV Medical Association) showed the beneficial effects of PEP, and how high the success rate is for the prevention of HIV.
In this particular study, twenty-five previously conducted studies’ data was collected and included for this review. Each of these studied the effects of PEP and HIV in primates, as they closely resemble the immune system of a human. In fact, they are so similar that the polio vaccine was tested and developed using these primates. These results were averaged together, and it was found that the contraction rate was 89% lower amongst the specimens that were introduced to PEP and successfully competed to treatment. A significant association was found between the timing of PEP introduction and the usage of these anti-HIV drugs.
In addition, studies have illustrated a reduction in vertical transmission of the virus via antiretroviral treatment of pregnant women. When given the drug within 48 hours of delivery, it was found there was a reduced incidence (which is the number of new cases) in newborns. Also, if you are pregnant and need to take PEP post-delivery, you should expect dual or even triple doses of PEP to ensure the efficacy. This is extremely important, as mother to child transmission is an extremely common way of transmitting the disease.
You may be wondering why primates were being used instead of humans. As previously mentioned regarding the similar immune system, there is also an ethical aspect to using human trials. Since HIV is such a potent virus, it is important to use identified treatments instead of potentially worsening the virus’ capability to destruct the human body. It is unethical to withhold a possibly life saving treatment to those who enlist in the study, and it is not fair to those who sign up to suffer while others benefit at random.
Where can I get more information and potential assistance?
As HIV has been considered an epidemic in the US, all primary care doctors, sexual health centers, department of health clinics, Urgent Care offices, and HIV/AIDS offices all offer free or low-cost testing. Planned Parenthood also provides testing. In %country%, it is essential to see what is around your area to ensure you can get care as soon as possible.
The CDC also offers both intensive and easy to digest statistics, facts, and other information for free. WHO also has information provided, and these are both excellent sources and can be considered the highest quality materials available. (CDC)
Unfortunately, prescription drugs are expensive. There are a multitude of programs and associations that are solely created to provide assistance to those who financially cannot afford HIV treatment. Besides having insurance, which many people may not have, there are sexual clinics and HIV/AIDS resource offices that provide low cost or even free treatment. While we cannot personally tell you where to go in %country%, a simple Google search of “%country% drug assistance programs, PEP, HIV” will warrant results.
In order to reduce the burden of your care, preventing additional infections and taking PEP properly will slow the infection thus keeping costs down. If you feel comfortable doing so, you may be eligible to participate in clinical trials of new forms of PEP. Depending on your area, you can search clinicaltrias.gov for trials that are recruiting near you.
If you are reading this article out of fear of having contracted the virus, please seek medical attention immediately. It is absolutely imperative that you get tested as soon as possible, as HIV progresses more severely with time, and can be prevented using something like PEP. Please get in contact with an agency immediately or go to your local Urgent Care if a prevention agency is not easily accessible, as spreading the virus unknowingly may lead to someone else’s (or your own) death. Knowing you contributed to the spread of an incurable disease will weigh on your conscience for the rest of your life, so please get medical advice immediately.