What is Post Exposure Prophylaxis (PEP)?
PEP refers to preventative medications given to a person after a known HIV exposure, or suspected HIV exposure. These medications consist of ARV's, the medication given to people who are already infected with HIV.
Exposure can occur when a person engages in unprotected receptive anal intercourse, when a HIV negative person has had unprotected sex with a HIV positive person, or in occupational (medical) settings (due, for instance, puncturing of skin with needles, bites or sharp objects that have come into contact with the blood of a HIV positive patient). PEP is administered with the hopes of decreasing the likelihood of HIV infection from the exposure.
HIV takes around 3 days to reach the lymph nodes (components of the immune system), and it takes a further 2 days to reach the blood cells. There is therefore a small temporary "window" during which the infection can possibly be blocked. PEP must be administered within 72 hours after possible exposure.
Studies have generally concluded that PEP ‘might' reduce the risk of HIV infection, but none have been able to say that it is a definite preventative.
Challenges associated with PEP
Although the benefits of PEP have been documented, it's use is not without some challenges. A practitioner will therefore consider the need for PEP thoroughly before prescribing it. Some of the challenges of PEP include:
Adherence Issues and the Problem of Resistance
It is a well known fact that HIV medications (ARV's) can have unpleasant side effects. Because of these side effects the people who have been exposed find it difficult to take their PEP regimen as prescribed and/or complete the four week course. Both of these barriers result in poor adherence. And as in the case of HIV+ people on medication, poor adherence leads to viral resistance and poor control of HIV. That could make the difference between the PEP being successful or not.
Possible side effects
Stomach and Intestinal Symptoms
Nausea
Vomiting
Diarrhoea
Weight Loss
Physical Symptoms
Dry Mouth
Fatigue
Peripheral Neuropathy
Fever
Rash
Emotional Symptoms
Depression
Where can you go for PEP in the Netherlands?
Have you had unprotected receptive anal intercourse (where the penis goes into YOUR anus)? Have you had unprotected sex with a person you know is HIV positive? Are you a health care worker and has your skin been punctured with a needle, bite or sharp objects after it has come into contact with the blood of a HIV positive patient? Then you have you been exposed to a possible HIV infection.
In the Netherlands you can go to your GP (huisarts in Dutch), or to the STI clinic at your local GGD. The health care workers there are trained to be able to determine whether you should get PEP.
This will only be effective if started within 72 hours after exposure to the HIV virus.
PEP is not easy on your body. No one can be certain that the infection with HIV will be successfully prevented. It will have many side effects and will only be effective after completion of the whole dosage, which takes 4 weeks. Prevention from exposure to HIV, for instance with the constant and correct use of condoms, still remains the best option. |
