(Post-Exposure and Pre-Exposure HIV Prophylaxis For HIV-PEP/PrEP)
According to WHO, Post-exposure HIV prophylaxis is a short-term antiretroviral treatment to reduce the chance of HIV infection after exposure.
Post-exposure prophylaxis (PEP) is a measure taken to prevent a permanent infection of HIV after an exposure. This process involves taking HIV drugs immediately after a possible exposure to the HIV virus.
Prophylaxis is another word for protection; therefore post exposure HIV prophylaxis can be referred to as after exposure protection. It is therefore possible to protect yourself from the HIV virus even after you had been exposed by unprotected sex, accidental cuts or any other known method of transmission.
PEP can only be effective if it is taken as soon as possible, at most 72 hours or three days after exposure. The drug is usually administered for 28 day (4 weeks)
The PEP method is only a preventive method and cannot be effectively used to cure the disease for persons who are already tested positive.
Note that failure to complete PEP administration for 28 days could result in resistant strains of the virus as common with drug abuse.
Types of PEP
There are basically two types of post exposure HIV prophylaxis (PEP) namely, occupational and non-occupational PEP. Occupational PEP is treatment taken after exposure during work. This is common with Health workers.
Non-occupational PEP is treatment taken after exposure outside the work place.
How PEP Works.
About 72 hours after infection, the virus focuses on infecting cells at the site of exposure, usually the penis, vagina, anus or cut. This period is known as the window period, a stage where the virus is not yet spreading. Taking Post-exposure HIV prophylaxis medications during the window period can prevent the virus from replicating and spreading from the initial site of infection. The initially infected cells would later die out there by removing the virus permanently.
PEP/PrEP – Antiretroviral drugs
Antiretroviral drugs can be classified into Nucleoside reverse transcriptase inhibitors (NRTIs), Non-nucleoside reverse transcriptase inhibitors (NNRTIs), Protease inhibitors (PIs), Integrase inhibitors (INSTIs), Fusion inhibitors (FIs), and Chemokine receptor antagonists (CCR5 antagonists). This classification is indicative of the point of viral development where the drug acts.
HIV drugs are only to be taken with the directive of a Healthcare personnel as some side effects and drug interference had been associated with antiretroviral drugs. Some of the side effects associated with post exposure HIV prophylaxis (PEP) drugs include neutropenia, anemia, nausea, fatigue, malaise, headache, insomnia, asthenia, abdominal pain, diarrhea, and in rare cases, pancreatitis, Nephrolithiasis, crystalluria, hematuria, nausea, headache, indirect hyperbilirubinemia, elevated liver function tests (LFTs), and hyperglycemia.
These complications can be well managed with the help of a medical Professional.
Caution should be used when taking antiretroviral drugs with other drugs. Drug interference with other drugs, especially bone marrow suppressive drugs could result in complications.
Note that PEP is for emergency situations and not a regular protection for people who are frequently exposed to the virus. Another method, Pre-exposure HIV Prophylaxis (Prep) could be used by persons who are frequently exposed to the virus to protect themselves from infection.
Pre-exposure HIV prophylaxis, or PrEP, is a method prescribed for HIV negative people who are frequently exposed to the virus and thus are substantially at high risk of getting it. This method requires the individual to take the antiretroviral pill every day. The pill, also known as Truvada, contains tenofovir and emtricitabine,which are drugs used in combination with other medicines to treat HIV.
Truvada prevents the replication of the virus in a cell by blocking the enzyme, HIV reverse transcriptase. Therefore a person on proper PrEP medication would be protected from getting a permanent infection by the virus.
When taken correctly, Truvada would cut the risk of HIV infection in people at high risk by over 90%. Note that if not taken consistently, the risk of getting infected is highly increased.
When combined with condoms and other prevention method, Truvada can give protection to about 99%.
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Important Points to note
- When starting, it takes about 7 days of consistent taking of the drugs before it reaches a high level of protection against HIV.
- People need to continue using pre exposure HIV prophylaxis (PrEP) for four weeks after the last exposure to ensure protection. This is to give time for infected cells to die.
- PrEP is neither a form of protection for pregnancy and other sexually transmitted diseases nor a cure for HIV.
- Although most people on PrEP show no side effects, Truvada has been observed to show some side effect similar to antiretroviral drugs in few clinical trials. This could range from nausea, weight loss, headaches and increase in serum creatinine.
Since the discovery of the virus that causes AIDS in 1983, several effort have been made by both National and International Health Organizations to control the spread of the disease. This aggressive HIV research resulted in the discovery of several methods used in preventing and controlling the spread of the virus. Two Research areas that had shown hope for a HIV free future is gene therapy and vaccination.
Gene therapy: Though antiretroviral therapy had been effective in treating the HIV virus, there had been complications of cumulative toxicity, incomplete immune restoration and emergence of drug resistant strains of the virus. The cell gene therapy offers hope of overcoming these shortfalls in HIV treatment. Persons with homozygous deletion of the CCR5 human gene were found to be resistant to the most commonly transmitted HIV strain. This method of treatment was found to generate resistance in patients own cell. Although the success rate had not been 100%, Gene therapy holds great promise for a HIV free world.
Vaccination: Research to discover a HIV vaccine had reached level of clinical trials. Several clinical trials had shown hope for a future HIV vaccine.