What is Pep?
PEP stands for ‘Post Exposure Prophylaxis’.
PEP is used after unprotected sexual contact, drug using or other methods of exposure considered to be ‘high risk’ for HIV. The person at risk can access medication that may limit the likelihood of becoming HIV positive.
PEP is not just about medication but also involves testing for HIV and other Blood-Bourne Infections (BBI’s), Sexual Health Screening (SHS) for sexual or related risks, counselling and comprehensive 6 month follow up
How does PEP work?
PEP can be given within 72 hours of exposure and would have to be taken for 28 days. It is important to note that if ANY dose is missed, or the four week course not completed, then this will reduce the chances of the treatment working and as with any prescription drug there are prescription charges involved.
If a dose is missed or forgotten then it should be taken as soon as it is remembered and the regime continued at that new time.
The medications prescribed for PEP are the same drugs, anti-retrovirals, that people living with HIV are prescribed. Different combinations are available and are as effective as any other.
As said, PEP is given in the hope that it will stop HIV from infecting the person’s immune system in the 72 hours after exposure but there is no ‘guarantee’ that it will work. Even so, it is thought to have an 80% or chance of effectiveness.
The person who has had the risk theoretically enters a ‘window period’ whereby they technically could be seroconverting to HIV but because the standard HIV antibody test actually tests for our reaction to HIV - and not the virus itself - & these antibodies can take up to 3 months to appear, the person could be positive but test negative.
This window period means the person could be more infectious (as HIV rapidly replicates when it is first transmitted) and so safer sex and/or safer drug using behaviour are particularly important during this time. In theory PEP would stop HIV replicating - but this is not certain and should never be assumed.
The HIV test at 6 weeks is to see the person’s status after finishing the PEP medications; at 3 months at the end of the ‘normal’ window period; and at 6 months to finally give the ‘all-clear’. The 6 month HIV testing is important as, again theoretically, PEP can extend the window period.
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When would PEP be used?
PEP is used by determining: • The method of exposure with its estimated risk (anal, vaginal or oral sex, protected or unprotected – i.e. using a condom - for example) • The risk of the source - the person with whom the person at risk has had sexual contact with (or any other risk-related contact) • Co-factors associated with the source and exposed individuals (viral load, other STI’s, Skin and penetrative tears or injuries)
Who can use PEP?
Anyone who has had a ‘risk exposure’ that is deemed to be eligible.
How do I access PEP?
PEP can be accessed through Emergency Departments, from a sexual health or HIV service, or from a GP who prescribes PEP.
For more information call the NSW PEP 24 Hour Pager Service:
1800 PEP NOW (1800 737 669)
A trained clinician will call you back to assess the risk and provide appropriate information
When wouldn’t PEP be appropriate?
• When the risk is not deemed to be sufficient to warrant the medication. • Where the treatment risks from PEP medications are greater than the risk of exposure
The health professional evaluating the risk will make a clinical judgement considering any other factors that may be relevant. The persons’ ability to complete the full 28-day course is another very important factor to consider before recommending PEP.
There is a difference between ‘occupational exposures’ (health care workers that may have a risk, such as a needlestick injury) and ‘non-occupational exposures’ (normally called NPEP).
What are the effects?
Adverse side effects caused by PEP medications are frequent and well recognised. While some people experience no side effects at all, most probably experience some mild to moderate side effects which might include nausea, rash, headaches and fatigue.
The prescriber will provide information on side effects and the drug company information that is provided with the medications should also be read.
Any person prescribed PEP will need to monitor the side effects and seek medical assistance if they feel they can't cope.
Further information can be obtained at:
http://www.ashm.org.au/guidelines/hiv-guidelines/pep/pep-guidelines
