It stands for Post Exposure Prophylaxis. It means If you get exposed to HIV virus there is a short window period of 72 hours that under supervision of an experience doctor you could take special anti viral medicine. In this way your HIV infection might not get finalized and you increase your chance that you remain HIV negative !
The most effective methods for preventing human immunodeficiency virus (HIV) infection are those that protect against exposure to HIV. Antiretroviral therapy cannot replace behaviors that help avoid HIV exposure (e.g., sexual abstinence, sex only in a mutually monogamous relationship with a non infected partner, consistent and correct condom use, abstinence from injection-drug use, and consistent use of sterile equipment by those unable to cease injection-drug use). Medical treatment after sexual, injection-drug--use, or other non occupational HIV exposure* is less effective than preventing HIV infection by avoiding exposure.
How effective is this method:
There is no randomized, placebo-controlled clinical trial to check the true effectiveness of the treatment, and probably will never be a clinical trial because it is unethical to put people life at risk of HIV infection in order to test a drug. However, it seems to be effective . This approach is recommended by CDC and you could get more information on that from cdc.gov.
There are some data available from animal study and health care workers who got exposed with infected blood or HIV positive pregnant mothers who got similar approach which might sometimes reduce the risk for HIV infection after exposures by getting PEP.
Qualification: Not everyone would be qualified for the treatment. We evaluate the situation case by case. For example: if you have unprotected intercourse with HIV positive person then you will be a strong candidate.
How much does it cost: PEP management is slightly different from person to person. Anti- HIV PEP medicine, diagnostics and follow up for one month have cost involve, but if you become HIV positive then you need all of those for life which is much more expensive than one month. We have done some arrangment with speciality HIV Rx Pharmacy to give discounted medicine to our PEP patients, however you have option to go to any pharmacy you like to get your PEP medicine.
In conclusion, it will be the cheapest investment of your life for 30 days if it works and change your destiny. However, not everyone is candidate regardless of affordablility. We evaluate and inform you if you are andidate when you come for initial PEP consultation.
72 Hours: You have only 72 hours after exposure to HIV to take PEP. The sooner the better. You should not wait for last minute. You have to consider many elements such as, the time you need to spend in the clinic in order to get evaluated, the time you need to spend in pharmacy in order to fill your prescription. Pharmacy dispensing time and the most important of all unexpected obstacle such as getting flat tire, trafic on the way you come to the clinic, missing appointment or just simply cancellation of your appointment by act of God or other reason by us.
If you start on early hours then you always have time for PLAN B.
We do not guarantee or take no responsibility if you are late for your PEP treatment for any reason or if you acted on clinic non operation hours, unavailability of appointment financial cost of PEP management such as paying for your prescription . This is not the time in your life for procrastinating.
Real Case Report:
I will give you 2 examples.
I tried it myself:
When I was doing my residency in MMC hospital in Phoenix Arizona, the big splash of blood scatered on my face while my intern was placing Swan-Gans cath in patient's chest. I was devstated and very afraid of getting HIV. At that time I was notified by hospital of post exposoure prophylaxis (PEP) . I was given PEP medicine and fortunately I remained HIV negative by subsequent testing by my teaching hospital.
I gave it to my patient:
We received the phone call from a doctor who had sexual contact with a new partner which he met at a bar. After the sexual contact he noticed that his genitalia is contaminated with the girl's blood as she was menstruating. He became anxious and started questioning her just to find out that she was HIV positive. We initiated post exposure prophylactic treatment as last hope to protect him against HIV infection. He took PEP treatment recommended by us for one month and follow up for 6 months as he was finally declared as HIV negative. We could never find out what would be his HIV status if he had not taken PEP treatment, but that was the only option he had. One of the most important aspect of this example is that he was a doctor himself. HIV does not care about your status if you are poor, rich, prisoner or president. HIV is life changing syndrome it will impact your health, your financial status, your relationship and many other aspect of your life so use protection and get tested routinely and do not put yourself and public at danger.
Blood transfusion > Needle Sharing injection Drug Use> Receptive Anal Intercourse > Precautions Needle stick > Receptive Penile Vaginal Intercourse > Insertive Anal intercourse > Incertive Penile-Vaginal Intercourse > Receptive Oral > Incertive Oral
Because persons who are infected with HIV might not be aware they are infected, baseline HIV testing should be performed on all persons seeking evaluation for potential HIV exposure. If possible, this should be done with an FDA-approved rapid test kit (we can do it in 15 minutes). If you are already HIV positive then you were not aware of it then maybe you do not need PEP and you need to be seen and follow up for your HIV treatment.
Is There Any Test to Detect HIV Exposure Before PEP ?
There is no test to detect HIV within first 72 hours after possible exposure. It makes sense because if there is chance to detect HIV in the blood then there is no benefit of PEP. The Whole Idea of PEP is to prevent HIV to enter the bloodstream. If HIV infect the blood then there is nothing you can do to reverese the course and become HIV negative again. Making HIV positive to HIV negative is ultimate cure that we don't have as of yet in practice of medicine in the world.
use variety of test as follow in order to detect early HIV in our patients as follow:
HIV-1 virus RNA down to impressive 20 copies/mL (supersensitive) to monitor viral load in established HIV-1
infected individuals. (Specimens with viral loads greater than 10,000,000
copies/mL will be reported out as >10,000,000 copies/mL).
2)HIV Pro viral DNA Detects
the presence of HIV-1 Proviral DNA down to impressive 35 copies/million cells in peripheral
blood mononuclear cells that could potentially reactivate in HIV-1 positive
patients with undetectable viral loads (following antiretroviral therapy). Also
detects proviral DNA in individuals recently exposed to HIV but prior to
production of HIV-specific antibodies (including neonates of HIV-positive
mothers, accidental HIV exposure).
HIV-1 virus RNA down to 75 copies/mL to monitor viral load in established HIV-1
infected individuals (specimens with viral loads exceeding 500,000 copies/mL
will be run on dilution). Accurate for quantitation Group M subtypes (A-G)P24 Antigen.
4)P24 Ag is a protein product of the gag gene of HIV . As a viral, rather than host It appears with renewed viral replication. The reappearance of P24 antigen usually means progression to AIDS. Detection of P24 antigen could assist for early diagnosis of HIV as well.
5)Western Blot Separate HIV protein and glycoprotein in serum. This will detect various component such as Gp120/160 gp41 and etc.This test means to confirm HIV antibody positive patient of them being truly HIV positive in order to eliminate false positive test.
6)Viral load Test, It will check amount of the virus floating in serum, this will assist clinician to treat the patient with antiviral therapy and evaluate the progression and stage of the HIV.
7)Pool Sampling RNA, because an acute infection, prior to sero-conversion, is usually accompanied by high viral titers
(10E5-10E7), it is possible to identify viral NA with sufficient sensitivity in pools of >100 samples per test. This assay has been optimized to detect 1-5 copies/ml of HIV Viral RNA in a 512 specimen pool. The Sensitivity of tests per individual sample included in the pool is approximately 2000 copies/ml. This test has been approved for the screening of plasma product.
8)HIV antibody test will detect HIV 1/2 antibody in the body. There are many type of these tests available such as EIA, Immunoassay. It is the only FDA approved test for screening for HIV.
9) 4TH GENERATION HIV TEST, it is design to more accurately detect HIV upon screening. in family of HIV testing, 4th generation is the latest
If patient is candidate for Post exposure prophylaxis then candidate should have follow up evaluation and testing based on CDC recommendation. HIV medicine has risk and side effects and we need to check your liver, kidney and blood test to make sure the medicine is not effecting your health.
Our complete PEP management program will cover all these area till you get final test in 6 months to confirm your treatment has been successful and you are HIV negative.
Possible Early HIV infection Symptom (retroviral syndrome)
Fever , Headache , Tiredness, Enlarged Lymph nodes
Possible Later HIV symptom(before AIDS)
- Lack of energy
- Weight loss
- Frequent fevers and sweats
- Persistent or frequent yeast infections (oral or vaginal)
- Persistent skin rashes or flaky skin
- Pelvic inflammatory disease in women that does not respond to treatment
- Short-term memory loss
Window Period & Test Timing:
There are many tests available to detect HIV (EIA, Immunoassay, western blot, DNA PCR, Antigen testing, RNA PCR, quantitative viral load etc). The standard HIV test is a HIV antibody test. It will give you your HIV status (must always consider window period and future testing). It takes time for our body to produce antibodies against a HIV infection, so in the early acute phase of infection patients could be infected but the antibody test could come back negative. You must always test again in 6 months to confirm your result.
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