Post-Exposure Prophylaxis (PEP) is any prophylactic (preventive) treatment started immediately after exposure to be pathogen (such as a virus) with the aim to prevent infection.
PEP is the use of Antiretroviral Therapy (ART), often becoming the standard of care for healthcare workers, who hold on to the risk of occupational exposure to HIV. PEP should ideally be initiated within 72 hours of exposure, failing which is not advised.
Men/Women who were involved in any form of unprotected anal or vaginal intercourse, receptive fellatio with ejaculation with:
A known HIV-infected partner
HIV at-risk groups (commercial sex workers, IV drug users, men who have sex with men - including bisexual men)
A person who was forced into any sexual act involuntarily (raped)
A detailed history of the exposure if crucial in evaluating a patient. An assessment will then be done by the doctor to determine the likelihood of HIV transmission. The level of risk can be estimated with the following table:
The patient will then be advised on the risks, benefits and alternatives of PEP. Should the decision be made to proceed with treatment, it would be important to follow-up for: potential side effects of the medications, repeat HIV screenings as well as reinforcement of counselling messages.
The Department of STI Control Clinic (DSC Clinic) will prescribe the following drug combination for PEP to work to its fullest extent:
Combivir [Zidovudine 300mg/Lamivudine 150mg] 1 tab, twice a day
Kaletra [Lopinavir 200mg/Rtionavir 50mg] 2 tabs, twice a day
The full course for this PEP drug combination will be for a duration of 28 days, at the cost of approximately $650.
Baseline HIV test is done before starting PEP.
A full blood count, liver and renal function test may also be done. These tests will detect any pre-existing abnormality prior to treatment and can/will be repeated if necessary.
Patient will also be reviewed after the 2nd and 4th week to assess compliance and possible side effects of medications prescribed with reinforment prevention messages.
Any drugs prescribed have the potential possibility of side effects.
These symptoms includes nausea and diarrhoea. If ZDV is prescribed, most side effects are contributed to the dosage, and is usually haematological, for example, anemia, granulocytopenia, anorexia and/or rash.
It is advisable to check with your healthcare provider on what are the possible side effects on the medications being prescribed to you.
The Department of STI Control Clinic (DSC Clinic)
31 Kelantan Lane c/o DSC Clinic
Communicable Disease Centre (CDC)
11 Jalan Tan Tock Seng c/o Tan Tock Seng Hospital
Exposure to saliva, urine, tears and sweat are not thought to be infectious
HIV transmission from splashes of contaminated fluids to mucosal surface (i.e. nostrils, mouth, lips, eyelids, ears, genital area and the anus) or non-intact skin is likely to be low, although it has not been accurately justified
PEP treatment is not 100% effective, best reports quote that PEP can potentially decrease the possibility of transmission by 81%