HIV PEP for Emergency Prevention

Yes, an HIV test is absolutely mandatory before we can dispense PEP.

This initial test is crucial, but not for the reason you might think. We are not testing for the exposure event that just happened; instead, we are establishing your baseline HIV status to ensure you are currently HIV-negative.

• Why is this essential? – PEP is a potent combination of antiretroviral drugs used to prevent HIV infection. It must never be used by someone who is already HIV-positive. Taking PEP when you are unknowingly already infected could lead to the development of drug-resistant HIV strains, making lifelong treatment much more complicated.
• The Elyon Clinic Process – At your urgent consultation at Elyon Clinic, we will perform a rapid, 4th-generation HIV test. This test is highly accurate and can detect both the HIV antibody and the p24 antigen (a protein that appears early in infection). A negative result confirms you are eligible to start the 28-day PEP course immediately, as time is of the essence. We will also screen for other Sexually Transmitted Infections (STIs) to ensure comprehensive care.

In Singapore, the cost of HIV PEP generally ranges from $1,500 to $2,000 for the full 28-day course. The price varies depending on the type of antiretroviral medications provided, consultation fees, and whether additional HIV testing is included throughout and after treatment.

At Elyon Clinic, HIV PEP is offered as an emergency medical prevention option to reduce the risk of HIV infection after a high-risk exposure such as unprotected sex, sexual assault, or a needlestick injury. Our doctors will assess your situation immediately and start treatment as quickly as possible, ideally within 72 hours (3 days) of exposure for maximum effectiveness.

Your HIV PEP journey at Elyon Clinic includes:

✅ Doctor assessment and ongoing monitoring

✅ A 4-week (28-day) prescription of MOH-approved HIV PEP medication

✅ Follow-up HIV testing for accuracy and peace of mind

As part of your follow-up, HIV tests may be recommended at different intervals. Based on recommended testing windows, the usual pricing at Elyon Clinic is:

• HIV RNA/DNA PCR Test (10–14 days): around $600
• HIV Duo Lab Test (4th Gen) at 2–4 weeks: $80
• Rapid Combo Antigen/Antibody Test: $120
• Rapid Oral HIV Antibody Test (more than 4 weeks): $80

Your doctor will explain which test is best suited for each stage, ensuring testing accuracy while avoiding unnecessary costs.

If you think you may need HIV PEP, please do not delay. Every hour matters – the sooner PEP is started, the more effective it is at preventing HIV infection.

No, PEP is highly effective, but it is not 100% guaranteed. It is a crucial safety net that dramatically reduces the risk of HIV transmission, but its efficacy depends on several critical factors:

• Effectiveness Rate: When started within the crucial 72-hour window and taken exactly as prescribed for the full 28 days, PEP is estimated to reduce the risk of HIV infection by approximately more than 80%.
• The Time Factor is Paramount: The sooner you start, the better the drugs can work to prevent the virus from replicating and establishing a permanent infection in your body. Every hour counts. Delaying treatment beyond 72 hours significantly diminishes its protective effect, which is why we prioritise immediate assessment.
• Adherence is Key: Failure to take the medication daily, missing doses, or prematurely stopping the 28-day course are the most common reasons PEP fails. The protective drug levels must remain constant in your bloodstream for the entire four weeks to clear any potential virus.

While moderate alcohol consumption is generally not known to stop the anti-HIV drugs in PEP from working, it is strongly advised to avoid or severely limit alcohol during the entire 28-day course. The decision to avoid alcohol is primarily based on these critical reasons for your health and treatment success:

• Worsening Side Effects: PEP medications, though modern regimens have minimal side effects, can sometimes cause mild nausea, headaches, and fatigue. Alcohol can drastically worsen these digestive and neurological side effects, making the 28-day course much harder to tolerate.
• Protecting Your Liver: Both alcohol and the antiretroviral drugs in PEP are processed by your liver. Combining them puts unnecessary and potentially harmful strain on this organ. At Elyon Clinic, we monitor your liver function with blood tests, and adding alcohol increases the risk of abnormal liver enzyme levels.
• Adherence Risk: Drinking, especially binge drinking, makes it much easier to forget to take a dose, take it at the wrong time, or skip it entirely. Perfect adherence is vital for PEP to work effectively, and anything that compromises this, like alcohol, should be avoided.

No, in Singapore and according to major international guidelines, PEP is generally not recommended if the source person is reliably known to be HIV-positive and has a sustained undetectable viral load (UVL).

This is based on the robust scientific principle known as U=U (Undetectable = Untransmittable):

• The U=U Principle: When a person living with HIV is on effective Antiretroviral Therapy (ART), their viral load (the amount of HIV in their blood) becomes so low that standard tests cannot detect it. At this undetectable level, HIV cannot be passed on through sexual contact, even without a condom. The risk of transmission is effectively zero.
• What the Doctor will Ask: At Elyon Clinic, we will carefully assess this. If the source partner’s undetectable status can be medically confirmed (e.g., through a recent viral load test result), PEP may be deemed unnecessary, saving you from a month of medication and potential side effects. However, if there is any doubt about the partner’s adherence to their ART, their test results, or the exposure was non-sexual (e.g., sharing a needle), the doctor will likely recommend starting PEP out of an abundance of caution.

To properly assess your risk and determine if PEP is the right and necessary intervention, the doctor at Elyon Clinic will conduct a detailed, non-judgemental, and confidential risk assessment. You must be prepared to answer honestly:

The Nature of the Exposure:

• What was the potential exposure? (e.g., unprotected anal or vaginal sex, condom breakage, needle sharing, sexual assault).
• Were you the receptive or insertive partner?
• Was there ejaculation or blood exposure? The type of exposure dictates the level of risk.

The Timing of the Exposure:

• When exactly did the event happen? This is the most crucial piece of information, as PEP must be started within 72 hours.

The Source Person’s Status:

• What is the HIV status of the source partner? (e.g., known HIV-positive, status unknown, known negative).
• If HIV-positive, are they on Antiretroviral Therapy (ART) and is their viral load undetectable?

Your Medical History:

• Have you taken PEP before?
• Are you currently on any other medication, recreational drugs, or supplements?
• Do you have any pre-existing medical conditions, especially related to your liver or kidneys? This helps the doctor choose the safest and most effective PEP regimen for you.

Missing a dose of PEP is a serious concern because it can allow the HIV virus a window to replicate, potentially leading to treatment failure. You must take immediate action and contact Elyon Clinic for advice.

• The General Rule (Less than 12 Hours Late): If you remember you have missed a dose and it has been less than 12 hours since your scheduled time, take the missed dose immediately. Then, continue with your next dose at the regular time.
• The Critical Rule (More than 12 Hours Late): If you remember and it has been more than 12 hours since your scheduled time, do not take the missed dose (do not double up) and simply wait to take the next scheduled dose.
• Contact Your Doctor Immediately: Regardless of the time frame, you must call Elyon Clinic. We need to know this information to assess if the lapse has compromised the overall effectiveness of your 28-day course and if any further monitoring is required.