Introduction
When you think that you have been exposed to the HIV virus, it is best to get treated immediately, and if not immediately, then within the next seventy-two hours. Going to a clinic that provides up-to-date and effective HIV PEP (Post Exposure Prophylaxis) could seriously influence the outcome of your risk encounter.
PEP is a preventative treatment that is initiated immediately after exposure to the HIV virus, or any time after a possible HIV exposure, usually within the next 72 hours. HIV PEP is an attempt to prevent the exposure from progressing into an actual infection.
Anyone who has experienced the failure of a condom (or the breakage of a condom) is in need of an urgent consultation at an HIV PEP clinic in Singapore. Going to a HIV clinic will be the best chance you have to stop any potential infection.
People who have had unprotected sexual intercourse with a partner that is known to have HIV, and victims who have been forced to participate in a sexual act without their consent, should consult an HIV clinic in Singapore.
People who have been exposed to HIV need various investigations and checkups, such as screening for other sexually transmitted diseases (STD) and HIV testing. When a person goes to a STD clinic in Singapore, their physician would ask them for a comprehensive sexual history to determine their risk for HIV exposure and transmission.
After risk assessment, the patient will be told whether they require HIV PEP. They will also be informed of the side effects of antiretroviral medications, PEP benefits, and the various PEP drug regimes. The side effects of PEP should be considered before deciding upon treatment. They can include nausea and diarrhea, and you should discuss these issues with your healthcare provider before initiating PEP.
Current Consensus on HIV PEP
Following a suspected exposure to the HIV virus, there is a small window of opportunity whereby physicians can initiate antiretroviral therapy to minimize the risk for a systemic HIV infection in the person exposed. This preventive therapy is utilized in both occupational and non-occupation exposures.
The chances for HIV PEP success depend upon numerous factors, including the efficacy of antiretroviral drugs used, the time period between exposure and initiation of HIV PEP, the route of HIV exposure, the dose of exposure (that is, the amount of virus you are exposed to), and ultimately, patient compliance to the antiretroviral regime.
Therefore, it is paramount that you complete your PEP course of medications for maximum benefits. Failure to comply with medical instructions can result in treatment failure and HIV seroconversion.
There is a current consensus that antiretroviral therapy should be started as soon as possible after exposure to maximize benefits of HIV PEP. This course of antiretroviral drugs should be continued for at least 28 days (4 weeks).
The US Department of Health and Human Services (2005) recommendations for non-occupational HIV post exposure prophylaxis is currently undergoing revisions, but the antiretroviral regime used for the 2013 guidelines for occupational exposures is perfectly suitable for non-occupational exposures as well. This regime is also recommended by the New York State Department of Health AIDS institute’s 2013 guidelines on non-occupational HIV PEP.
The latest PEP regimes are known to have lesser side effects and better efficacy. Our clinic uses various HIV PEP regimes, depending upon patient profile and various medical considerations like pre-existing medical conditions and the possibility of drug resistant strains.
Clinical Assessment and Risk for Transmission
The complete evaluation of a patient for HIV PEP is never complete without the following considerations:
1) Risk assessment following non-occupational exposure.
2) Comprehensive HIV and STD (Sexually Transmitted Disease) screening and treatment.
3) Risk reduction behavioral counseling to reduce disinhibited or risky habits.
Usually non-occupational HIV post exposure prophylaxis is only recommended within 72 hours of exposure. For exposures more than 72 hours, HIV PEP is generally not recommended except for cases with the highest risk.
Higher risk exposures where HIV PEP is usually initiated include the following situations:
1) Receptive and insertive anal or vaginal intercourse with a known HIV-infected partner, or when the partner’s HIV status is not known.
2) Needle sharing in intravenous drug usage.
3) Injuries involving exposures to potentially infected bodily fluids (for example, blood and semen) where the source is known to be HIV positive, or when the HIV status of the source is not known. These injuries include human bites during altercations, accidents, assaults, or needle-stick injuries.
Some cases of perceived HIV exposure have lower risks, and require a case-by-case evaluation by the physician for suitability of HIV PEP, such as:
1) Receptive and/or insertive oral-vaginal contact.
2) Receptive and/or insertive oral-anal contact.
3) Receptive oral-penile contact with or without ejaculation.
4) Insertive oral-penile contact with or without ejaculation.
In such lower risk exposures, the physician might consider starting the candidate on HIV PEP if the following factors are involved:
1) Source is HIV positive with a high viral load.
2) Patient’s oral mucosa is not intact or has open wounds or lesions.
3) Any form of blood exposure. Sometimes the patient may not realize that there was blood involvement if the amount of blood was minute. Exposure to frank blood is usually an indication for HIV PEP.
4) The concomitant existence of genital ulcers or other forms of sexually transmitted diseases (STDs).
It must, however, be emphasized that the following exposures do not require HIV PEP:
1) Masturbation or heavy petting with no open wound or blood exposure.
2) Kissing or French kissing
3) Other forms of oral-to-oral contact (like mouth-to-mouth resuscitation in cardiopulmonary resuscitation).
4) Human bites that do not involve blood or open wounds.
5) Needle-stick injuries not involving recent contact with blood or bodily fluids. An example would be an unused needle.
Conclusion
So, if you are exposed and wondering what you should do, consult our family physician concerning HIV post exposure prophylaxis (HIV PEP). Although receiving treatment does not furnish you with a hundred percent guarantee of protection, it is your best chance after a high-risk exposure.
It is your best chance to be HIV-free.
