PEP : Post-Exposure Prophylaxis

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Post-Exposure Prophylaxis in Bangkok : ยาต้านฉุกเฉิน
Post-Exposure Prophylaxis in Bangkok : ยาต้านฉุกเฉิน

If you have had a high risk exposure to HIV in the last 72 hours. You are a potential candidate for PEP.

 

Factors that can increase the risk of HIV infection and you are a potential candidate for PEP due to:

  • The partner is known to be HIV positive AND is not on treatment.
  • Anal sex with penetration without condom
  • Vaginal sex without condom
  • Condom break
  • Presence of blood
  • Presence of cuts or ulcers
  • You are not circumcised
  • You have been exposed to potentially HIV infected body fluids
  • Your exposure was less then 72 hours ago
  • Partner of unknown HIV status who belong to higher risk HIV group (e.g. MSM or from africa or S.E.Asia)
  • They penetrated you (Their penis, your arse) AND you don't know for sure whether they have HIV or not.

HOW DOES PEP WORK?

Once you are exposed to HIV, it take less than a week for the virus to establish itself within your body. Once it is established you will have HIV for the rest of your life. However, if you begin taking PEP in time, the anti-HIV drugs will prevent the HIV (that's already in your body) from reproducing and it DIES out before it has a chance to multiply.

WHAT HIV PEP DRUGS DO WE USE?

We use the latest gold standard PEP medicines with fewer side effects and better HIV prevention which will be taken for 28 days.

  • For adults: Tenofovir combined with either Tenofovir (TDF) and emtricitabine (FTC) as preferred backbone drugs and these are also the preferred drugs for treating HIV. The recommended third drug, which is also recommended by WHO and CDC as a preferred drug for HIV treatment, will be chosen by your doctor.

WHAT ARE THE HIV PEP SIDE EFFECTS?

With the new PEP drugs we use, side effects are very rare. Fewer than 1 in 100 of our patients actually develop any side effects.

Common side effects (<1%) include nausea, diarrhoea and feeling tired.

 

Rash and fever are uncommon (< 0.1%) side effects.

 

HOW MUCH DOES THE HIV PEP COST?

The usual costs invovled are:

1. Consultation                     600-1000 THB

2. Rapid HIV test                           500 THB

3. Rapid Hepatitis B virus test       500 THB

4. PEP Medications          3300-20300 THB

5. Treatment for possible sexually transmitted infections (additional cost)

 

WHAT ELSE SHOULD BE DONE?

Your doctor might advice that you get treatment as prevention for possible gonorrhoea/chlamydia/syphilis after unprotected sex or sexual accident.

 

YOU DON'T NEED PEP IF...
- You are confident that your partner doesn't have HIV.

- The partner is HIV positive and on successful treatment (Known as ‘undetectable viral load').

- Human bites

- Another person's semen gets in your eye.

 

 

 

WHAT WILL DOCTOR ASK ME?
The doctor will try to evaluate how likely it is you have actually been exposed to HIV before starting treatment.
Questions will include what sort of sexual or injecting activity or partner is likely to be HIV-positive.
At PULSE CLINIC and Sathorn International Clinic they have seen this 1600 times before, you're not the first and not the last. The doctor won't judge, He/She will be very helpful and make you feel at ease.

 

If you think you're at risk and need PEP, call us.

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Estimated HIV transmission risk per exposure for specific activities and events

  Activity Risk-per-exposure
Vaginal sex, female-to-male, studies in high-income countries 0.04% (1:2380)
Vaginal sex, male-to-female, studies in high-income countries 0.08% (1:1234)
Vaginal sex, female-to-male, studies in low-income countries 0.38% (1:263)
Vaginal sex, male-to-female, studies in low-income countries 0.30% (1:333)
Vaginal sex, source partner is asymptomatic 0.07% (1:1428)
Vaginal sex, source partner has late-stage disease 0.55% (1:180)
Receptive anal sex amongst gay men, partner unknown status 0.27% (1:370)
Receptive anal sex amongst gay men, partner HIV positive 0.82% (1:123)
Receptive anal sex with condom, gay men, partner unknown status 0.18% (1:555)
Insertive anal sex, gay men, partner unknown status 0.06% (1:1666)
Insertive anal sex with condom, gay men, partner unknown status 0.04% (1:2500)
Receptive fellatio Estimates range from 0.00% to 0.04% (1:2500)
Mother-to-child, mother takes at least two weeks antiretroviral therapy 0.8% (1:125)
Mother-to-child, mother takes combination therapy, viral load below 50 0.1% (1:1000)
Injecting drug use Estimates range from 0.63% (1:158) to 2.4% (1:41)
Needlestick injury, no other risk factors 0.13% (1:769)
Blood transfusion with contaminated blood 92.5% (9:10)

Sources: vaginal sex;1 anal sex;2 fellatio;3 2 mother-to-child;4 other activities.5

References

1. Boily MC et al. Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies. Lancet Infect Dis 9(2): 118-129, 2009

2. Vittinghoff E et al. Per-contact risk of human immunodeficiency virus transmission between male sexual partners. American Journal of Epidemiology 150: 306-311, 1999

3. Del Romero J et al. Evaluating the risk of HIV transmission through unprotected orogenital sex. AIDS 16(9): 1296-1297, 2002

4. Townsend C et al. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000-2006. AIDS 22: 973-981, 2008

5. Baggaley RF et al. Risk of HIV-1 transmission for parenteral exposure and blood transfusion. AIDS 20: 805-812, 2006

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