A PRESENTATION ON POST

EXPOSURE PPROPHYLAXIS

PURITY KAJUJU
LIVERPOOL VCT, CARE & TREARTMENT
27TH APRIL 2010
POST EXPOSURE PROPHYLAXIS (PEP)
 Administration of a combination of Anti-Retroviral
drugs (ARV’s) for 28 days following exposure to HIV.

 PEP is recommended for men, women, girls and boys at

risk of HIV infection.

 The 2004 National ARV guidelines suggest offering 2

ARV’s for PEP.

 The WHO/ILO PEP guidelines also recommend duo

therapy (WHO, 2007).
 Administered by a trained health practitioner
SOURCES OF EXPOSURE
1.
Body fluids containing HIV –
 High Risk: Blood, pus, breast milk
 Low risk – saliva,

2. Sexual intercourse - semen, vaginal

secretions

3. Needle prick injuries

RISK OF EXPOSURE

 dependent upon:
 health care personnel practices
 the prevalence of the illness
 the amount and frequency of exposure
WHEN TO PRESCRIBE PEP

High risk exposure + known source status, HIV positive

High risk exposure + Known source HIV negative + Risk factors

High risk exposure + Unknown source status

WHEN SHOULD YOU NOT OFFER PEP?

 After exposure through any route with low

risk materials (e.g. urine, vomit, saliva,
faeces) unless they are visibly bloodstained

 Where testing has shown that the source is HIV

negative, or if risk assessment has
concluded that HIV infection of the source
is highly unlikely
TIMING OF PEP FOR HIV

 The efficacy of PEP decreases with the length of

time from exposure to the first dose.

 Administering the first dose is a priority.

 Effective up to 80% if given within 72hrs, but ASAP

after the exposure.

 72 hours after assault, PEP is not effective, but offer

all other aspects of post rape care.
COMMON SIDE EFFECTS ARE

 nausea
 headaches

 tiredness

 general aches and pains

-Reduce SE by taking pills with food.

-These SE improve with time.
-Short course do not cause any long-term damage.
-Lab clinical monitoring important.
MONITORING FOR PEP
Baseline, within 3 days of starting PEP

Blood  Urine
• HIV  PDT – Pregnancy test
- HIV negative, continue  Microscopy
PEP.
- HIV positive, discontinue
PEP, refer to care.  (DNA Analysis)
 Hair
 Nail
 Hemoglobin level.
 ALT/Creatinine – Liver
clippings/scrapings
 Body Fluid
functions
PEP FOR SEXUAL ASSAULT
SURVIVORS
ASSESSMENT TO DETERMINE
WHETHER PEP IS INDICATED
 Assess and carefully weigh the
following factors:
 whether or not a significant exposure has

occurred during the assault

 knowledge of the HIV status of the alleged

assailant
 whether the survivor is ready and willing to

complete the PEP regimen

DEGREE OF RISK BASED ON TYPE OF
EXPOSURE
 significant exposure
 Provide PEP
 Where direct contact of the vagina, anus, or mouth with
the semen or blood of the alleged assailant, with or
without physical injury, tissue damage, or presence of
blood at the site of the assault.
 Or where broken skin or when mucous membranes of
the survivor have been in contact with blood or semen
of the alleged assailant.
 In cases of bites that result in visible blood.
CONSIDERING THE HIV STATUS OF
THE ALLEGED ASSAILANT
 Unless the identity and HIV status of the alleged
assailant has been clearly established to assist with the
decision-making:
 PEP should be promptly initiated when a significant risk
exposure has occurred.
 Even when the alleged assailant is known to be HIV
infected, the decision to recommend PEP should be based on the
nature of the exposure and the survivor’s ability to complete the
regimen.
 If prophylaxis has been initiated and the alleged assailant
is found to be HIV antibody negative, then PEP should be
discontinued.
FOLLOW-UP HIV TESTING

 HIV Antibody testing for 6 months post-

exposure at 6 weeks, 3 months, 6 months

 Viral Load testing not recommended unless HIV

Infection suspected
POST-EXPOSURE PROPHYLAXIS:
CORE PRINCIPLES
 Evidence is limited
 Balancing of risks vs. benefits
 Timing: the sooner the better, but interval
beyond which there is no benefit is
unclear
 Optimal duration unclear, 28 days is
recommended
 Decision making can get very complex
when resistance in PEP suspected
POST-EXPOSURE PROPHYLAXIS:
CORE PRINCIPLES

SEX PEP SHOULD BE CONSIDERED FOR

RISKY EXPOSURES AND DOES NOT APPEAR
TO INCREASE UNSAFE SEXUAL BEHAVIOR
FOR MOST RECIPIENTS.
Questions????

Thank you wonderful people!!