Results from a randomized controlled trial in Bangkok
Bangkok
Bangkok is the capital and most populous city of Thailand. It is known in Thai as Krung Thep Maha Nakhon or simply Krung Thep. The city occupies 1,568.7 square kilometres in the Chao Phraya River delta in central Thailand, and has a population of over eight million, or 12.6 percent of the country'…
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention is the leading national public health institute of the United States. The CDC is a United States federal agency under the Department of Health and Human Services and is headquartered in Atlanta, Georgia.
What is the Pep HIV treatment?
Aug 23, 2009 · Anemia, Fatigue, and HIV PEP treatment thailand. Bob Frascino, M.D. Aug. 23, 2009. ... In situations where there has been a significant HIV exposure, post-exposure prophylaxis (PEP) would be ...
When should I start PEP after HIV exposure?
PEP is the use of antiretroviral medication to prevent HIV infection in an HIV-negative person who has had a specific high-risk exposure to HIV. Such an exposure typically occurs through sex or sharing syringes (or other injection equipment) with someone who has or might have HIV. Exposure to HIV is a medical emergency, because HIV establishes ...
How is HIV status related to drug resistance in Pep?
Apr 28, 2021 · PEP, or post-exposure prophylaxis, is a short course of HIV medicines taken very soon after a possible exposure to HIV to prevent the virus from taking hold in your body. You must start it within 72 hours (3 days) after a possible exposure to HIV, or it …
Why are fourth-generation HIV tests recommended for patients with Pep?
Nov 01, 2021 · Post-exposure prophylaxis (PEP) has been established to effectively prevent HIV infection in an exposed individual when initiated within 2 hours (ideal) and no later than 72 hours after an exposure. Rapid and effective response to a reported HIV exposure are key to the successful prevention of HIV infection.
How much is PEP in Thailand?
How much does HIV PEP cost?
What does PEP treatment consist of?
Can HIV be cured with PEP?
PEP is not a 'cure' for HIV. PEP may prevent HIV from entering cells in the body and so stop someone from getting HIV. PEP isn't 100% effective.Feb 4, 2022
How successful is PEP?
Can I get PEP free?
How long does PEP treatment take?
How do I know if I need PEP?
How long after taking PEP should I get tested?
What causes PEP to fail?
Is taking PEP for 14 days effective?
Do I have to take PEP at the same time everyday?
Who can prescribe PEP?
Any licensed prescriber can prescribe PEP. Emergency medicine physicians are among the most frequent prescribers of PEP, given the need for immediate treatment after exposure. Clinicians working in ambulatory care practices can also ensure that their non-HIV-infected patients who report risk behavior are aware of PEP, and know how to access it.
How long is PEP good for?
Patients usually experience only mild side effects on the preferred PEP regimen. Most importantly, PEP is only taken for 28 days. In almost all cases, the benefits of HIV prevention outweigh any other risks posed by the medication. In a meta-analysis of 24 PEP-related studies, including 23 cohort studies and 1 randomized clinical trial, nausea, vomiting, diarrhea and fatigue were the most commonly reported side effects.
How to start a PEP?
Guidelines recommend the following baseline screening before initiating PEP: 1 HIV rapid test at baseline. If baseline rapid test indicates existing HIV infection, PEP should not be started. However, if rapid HIV baseline test is not available, there should be no delay in starting PEP. Oral HIV tests are not recommended for use among persons being evaluated for PEP. 2 Pregnancy test (if a woman is of reproductive age, not using highly effective contraception, eg IUDs or other long-active reversible contraceptives (LARCs), oral contraceptives, or properly used condoms, and with vaginal exposure to semen). 3 Serum liver enzymes 4 BUN/creatinine 5 STI screening#N#Persons being evaluated for PEP because of a sexual encounter should have STI-specific nucleic acid amplification (NAAT testing) for chlamydia and gonorrhea, and a blood test for syphilis 6 Hepatitis B testing, including hepatitis B surface antigen, surface antibody, and core antibody 7 Hepatitis C (HCV) antibody
What tests are needed for PEP?
BUN/creatinine. STI screening. Persons being evaluated for PEP because of a sexual encounter should have STI-specific nucleic acid amplification (NAAT testing) for chlamydia and gonorrhea, and a blood test for syphilis. Hepatitis B testing, including hepatitis B surface antigen, surface antibody, and core antibody.
How long should you follow up on PEP?
This is both to ensure adherence and to facilitate follow-up HIV testing at 30 and 90 days to determine if HIV infection has occurred. Additionally, people whose sexual or injection-related exposures result in concurrent acquisition of HCV and HIV infection might have delayed HIV seroconversion.
Is PEP effective for HIV?
PEP is only indicated for potentially exposed people without HIV infection. PEP is unlikely to be effective in people who have been exposed more than 72 hours before seeking medical assistance. PEP should be provided only for infrequent exposures.
Is PEP covered by insurance?
In many states, PEP is covered by insurance, including Medicaid. If the patient is not covered under insurance, there are assistance programs run by various manufacturers.
What is a PEP?
PEP, or post-exposure prophylaxis, is a short course of HIV medicines taken very soon after a possible exposure to HIV to prevent the virus from taking hold in your body.
What to do if you are taking PEP?
If you are taking PEP, talk to your health care provider if you have any side effect that bothers you or that does not go away. PEP medicines may also interact with other medicines that a person is taking (called a drug interaction).
Can you get PEP after HIV exposure?
In addition, if you are a health care worker, you may be prescribed PEP after a possible exposure to HIV at work , such as from a needlestick injury.
When should you use PEP?
PEP should be used only in emergency situations. It is not meant for regular use by people who may be exposed to HIV frequently.
Can you use PEP for HIV?
No. PEP should be used only in emergency situations. It is not intended to replace regular use of other HIV prevention methods. If you feel that you might exposed to HIV frequently, talk to your health care professional about PrEP (pre-exposure prophylaxis).
Is PEP effective for HIV?
PEP is effective in preventing HIV infection when it’s taken correctly, but it’s not 100% effective. The sooner you start PEP after a possible HIV exposure, the better. While taking PEP, it’s important to use other HIV prevention methods, such as using condoms the right way, every time you have sex and using only new, ...
Does health insurance pay for PEP?
If you’re a health care worker who was exposed to HIV on the job —Your workplace health insurance or workers’ compensation will usually pay for PEP.
What is the role of PEP in HIV?
Rapid and effective response to a reported HIV exposure are key to the successful prevention of HIV infection. PEP blocks viral replication:After percutaneous or mucosal exposure to HIV, local replication of virus occurs in tissue macrophages or dendritic cells (see Figure 1, below).
What can be done after the first dose of PEP?
Assessment of exposure, HIV and other baseline testing, and other related activities can proceed after the first dose of PEP is administered.
What is PEP in NY?
This guideline was developed by the New York State Department of Health (NYSDOH) AIDS Institute (AI) for healthcare practitioners in any medical setting (e.g., emergency department, sexual health clinic, urgent care clinic, inpatient unit primary care practice) who manage the care of individuals who request post-exposure prophylaxis (PEP) after a possible exposure to HIV. Despite the availability of prevention measures, exposures occur that pose the risk of transmission. Fortunately, with rapid initiation of PEP, infection can be blocked. Preventing new HIV infections is crucial to the success of New York State’s Ending the Epidemic Initiative.
How long does it take for a PEP to be initiated?
Exposure to HIV is a medical emergency:PEP should be initiated immediately—ideally within 2 hours of an exposure but no later than 72 hours after an exposure —because the effectiveness of PEP decreases over time after 2 hours.
How long does it take to start post exposure prophylaxis?
Initiation of post-exposure prophylaxis when an exposure is reported within 72 hours.
How old do you have to be to get PEP?
Sexual assault patients who are <18 years old now (by law) must be provided with the full course of PEP medications.
What are the 4 types of exposure to HIV?
Reorganization of the previous 4 guidelines into 1 document:This PEP guideline addresses management of 4 types of exposure to HIV: occupational, non-occupational (consensual sexual exposure, exposure through needle-sharing), sexual assault, and exposures in children. Icons throughout signal content specific to one exposure type (see the icon key above). The edition reflects a unified approach to the recommendations for all exposure types, with differences between exposure scenarios highlighted throughout.
What is PEP in HIV?
PEP, short for post-exposure prophylaxis, was first shown to be effective in preventing occupational exposure to HIV (needlesticks and blood splashes, etc.). This led researchers to study whether giving HIV meds shortly after sexual exposure might also work. But since the drugs used are all FDA-approved and available by prescription, it was not considered ethical to conduct controlled studies (in which half the participants get drug and half get a placebo, or dummy pill). So the only studies done have given meds to everyone in the study -- a useful source of data, but not a method that can conclusively prove whether this approach works. Still, results have been impressive: of 401 people treated in a PEP study in San Francisco in the late '90s, none seroconverted.
What is a PEP?
For people who are exposed to HIV on a regular basis, a more controversial approach is being studied: the use of HIV meds to prevent infection before exposure. Called PrEP, for pre-exposure prophylaxis, it is based on the common practice of using antiretrovirals to prevent HIV transmission in pregnancy.
How long does it take for PEP to work?
PEP is not a picnic. Side effects to HIV meds are often strongest in the first few weeks, and for PEP to be effective, it must be taken for at least 28 days. Choosing a regimen that will lead to the fewest missed doses and preparing for side effects (including what to do if they occur) is important. It's also necessary to check for any interactions with other drugs, including over-the-counter and street drugs.
Where is Truvada PrEP being tested?
The National Institutes of Health is preparing a safety and efficacy trial of Truvada PrEP in 1,400 MSM in Peru and Ecuador, and the CDC is in the planning stages for a U.S. study of the safety of Truvada PrEP. (For details on current PrEP studies, visit prepwatch.org .)
How soon after exposure to PEP?
Timing is critical when it comes to PEP. HIV meds must be started as soon as possible (recommendations vary from 36 to 72 hours after exposure), and continued for 28 days. The effectiveness decreases the longer treatment is delayed, so starting quickly is important. In many states, every organization working with people with HIV is required to have a policy in place to deal with occupational exposures so that employees don't have to scramble to find out what to do after an exposure occurs. People should know where to go for care before an exposure happens. If you're exposed in the middle of the night, don't wait until morning to call your doctor -- go to the nearest ER as soon as possible and take that first dose!
Is PrEP effective for HIV?
If PrEP is proven effective, understanding its impact on HIV risk behaviors will be critical. One of the greatest risks is that people will reduce their use of proven prevention strategies. Because no single strategy will likely be 100% effective, reducing transmission will require integrating all available methods -- both biomedical and behavioral. During trials, all participants must receive state-of-the-art HIV risk-reduction counseling and other proven HIV prevention interventions.
Does Thailand have clean needles?
But the Thai government, like that in the U.S., does not provide clean needles for drug users, and concerns have been raised about the ethics of testing an unproven prevention method when a proven intervention is not also made available.
How to manage the use of antiretrovirals?
Secondly, how to manage the use of antiretrovirals? The longer a person takes PrEP (two antiretrovirals) during undiagnosed HIV infection, the greater the chance of the virus developing resistance. An additional antiretroviral drug could be prescribed, so as to provide HIV treatment (three antiretrovirals). Alternatively, stopping PrEP for a week or two might make it easier for a correct diagnosis to be given .
Why are HIV tests inaccurate?
These test inaccuracies appear to be because antiretroviral therapy’s effect on HIV may extend to suppression of the immune system’s normal response to the virus. Tests rely on detecting HIV antibodies (part of the body’s immune response), but occasionally people taking treatment for a long period of time may lose some of their antibodies. This does not mean that HIV has been cured or removed from the body.
Can antiretrovirals slow down the replication of HIV?
The presence of antiretrovirals may suppress or slow the replication of HIV. As a result, the immune response and antibody production might be weaker than usual.
Can you get HIV before taking PrEP?
A similar phenomenon affects people taking pre-exposure prophylaxis (PrEP). People sometimes unknowingly acquire HIV just before starting PrEP and so take antiretrovirals during the earliest stages of infection. Less frequently, poor adherence or PrEP failure results in infection and the individual continues to take PrEP.
Can HIV be tested with rapid tests?
The presence of antiretrovirals may suppress the immune response and the production of antibodies. Rapid tests and self-tests should not be used to confirm HIV infection in people taking HIV treatment. In the case of repeatedly indeterminate test results in a PrEP or PEP user, seek expert guidance.
Is HIV self test inaccurate?
People taking HIV treatment. Rapid, point-of-care tests and self-tests are very occasionally inaccurate in people living with HIV who are taking HIV treatment.
Does HIV work after treatment?
It appears that the evolution of HIV antibodies over time is profoundly altered by prompt initiation of antiretroviral therapy. HIV tests do not always work the way they should after HIV treatment has been initiated very early in infection.
What is the HIV guideline?
The guideline offers recommendations on how to assess risk following a potential exposure to HIV, and how and when to prescribe post exposure prophylaxis medication. This includes both sexual and occupational exposures.
What happens if you are exposed to HIV?
If this was a sexual exposure, you may also be at risk of other sexually transmitted infections or an unwanted pregnancy.
What is PEP treatment?
What is PEP? PEP (post-exposure prophylaxis) is a course of antiviral medication you can take to prevent HIV infection if you have potentially been exposed to the virus. It must be started within 72 hours of an exposure to HIV and be taken correctly over a 28-day treatment period. PEP can be 1 tablet taken daily or a combination ...
Why is PEP taken?
PEP is taken after a known or suspected exposure to HIV to prevent HIV transmission.
How long does it take for PEP to work?
PEP must be started within 72 hours of an exposure to HIV and be taken correctly over a 28-day treatment period to be effective.
What is the best way to prevent HIV transmission?
Using clean, sterile injecting equipment. Taking pre-exposure prophylaxis (PrEP) – for people who are at risk of HIV transmission.
What does U=U mean for HIV?
achieving and maintaining “undetectable” HIV viral loads (U=U) if you are HIV-positive by taking HIV antiretroviral treatment (ART) as prescribed.
Does PEP protect against STI?
Can cause severe side effects in some people – such as nausea and vomiting, headaches, an upset stomach, diarrhoea or tiredness. PEP does not protect against other sexually transmissible infections (STI) such as: syphilis. gonorrhoea.
Is it safe to take PEP if you have HIV?
If your exposure to HIV is through a person with HIV who has an undetectable viral load, PEP is not recommended, as there is no risk of transmission.
What is HIV, and What is AIDS?
AIDS is the final stage of an HIV infection. HIV, human immunodeficiency virus, is the virus, while AIDS, acquired immune deficiency syndrome, is the condition brought upon by HIV infection. It occurs when the immune system is so severely damaged that a person is no longer able to fight off infections.
The Effects of HIV and AIDS on the Human Body
Once HIV infects the body, it directly attacks the immune system, gradually weakening defenses against invading diseases. Eventually, the virus will attack the entire body.
Contracting HIV
People can contract HIV though contact with blood, semen, vaginal fluid, and even breastmilk. The virus is most commonly passed on to others though sex and sharing needles – or by mother-to-child infection during pregnancy.
The 3 Stages of HIV Infection
The Acute HIV Infectious Stage is the first stage of HIV infection, occurring between 2-4 weeks after infection. Many people during this stage will begin to experience flu-like symptoms such as fever, sore throat, swollen glands, aches and pains, rashes, and headaches. These set of symptoms is known as acute retroviral syndrome or ARS.
HIV Infection and AIDS Treatment
Currently, there is no known cure for HIV infection and AIDS, but there are medications available to treat HIV infection.
