Protecting yourself against HIV with Post-Exposure Prophylaxis (PEP)

What is Post-exposure prophylaxis or HIV PEP Singapore?

HIV Post-Exposure Prophylaxis, PEP HIV, or simply PEP can significantly reduce your risk of a Human Immunodeficiency Virus (HIV) infection. HIV PEP is most effective if the treatment is started with 72 hours of the alleged HIV exposure. Of course, the sooner you start PEP the better. 48 hours is ideal. Anyone with a high risk of exposure to HIV can be prescribed the PEP HIV treatment. It includes undergoing Antiretroviral therapy (ART)/antiretroviral (ARV) medications for an entire month. The process is not unlike HIV PrEP (Pre-Exposure Prophylaxis). The only variation is that HIV PrEP is taken before any potential HIV exposure on a daily basis.

The HIV PEP routine is as simple as taking 1 pill per day for 4 weeks. It should be noted that PEP was designed to be only taken in emergency scenarios. It is not recommended for persons who are exposed to HIV on a regular basis. We cannot stress enough that PEP is not meant to replace other HIV prevention methods like practicing safe sex, pre-exposure prophylaxis, and the safety measures and protocols observed by a healthcare worker.

Do not turn HIV into AIDS.

Talk to our doctor!

Do I have to take an HIV test before PEP?

Yes, before accessing HIV PEP, HIV testing is usually mandatory. This is to rule out the possibility of the patient already being infected. If you are already HIV positive, the HIV PEP treatment will not be effective, and your doctor may prescribe other long term antiretroviral medications.

Is PEP considered safe and are there any side effects that I should be aware of?

The majority of people experience few or no side effects with the newer HIV PEP medications. However, some patients (less than 10%) may experience the following minor side effects:

• Loss of appetite and Nausea
• Diarrhea or loose bowels
• Muscle aches and fatigue
• Insomnia and lucid dreams

The good news is that these side effects usually resolve on their own with 5-7 days of starting the treatment. If you are experiencing side effects, notify our doctors so they can prescribe the appropriate symptom-relieving drugs. Thankfully, PEP causes no long-term side effects, and any unpleasant effects will disappear when you end your treatment. We also recommend that you disclose any other medications that you are on.

How many HIV PEP pills do I need to take in one day?

There is more than one HIV PEP treatment regime to choose from. Our doctors will evaluate your unique situation and recommend the most appropriate treatment regime.

What should I expect when I visit my doctor?

Our doctor will assess your individual risk level and whether or not PEP is right for you.

Then, you will be advised to take a renal function test. These tests are necessary to confirm that it is safe to start and continue the PEP treatment. If a patient has an underlying kidney condition, the timing and dosage of the PEP medication may have to be adjusted by the physician. We also cannot administer the PEP medication to a person who is already HIV positive and is unaware. Unfortunately, this can cause the virus to develop resistance to the treatment after the course is completed. Our doctor will fill you in on all the details regarding timing, indications, dosage, and side effects. Additionally, depending on your risk level, you may be advised to take STI screening tests.

What is my next step after I complete my HIV PEP course?

Once completed, you can make an appointment at the clinic to see your doctor. Repeat baseline HIV Test may be recommended at the following intervals:

• 1 month after HIV exposure
• 3 months after HIV exposure

We are aware that waiting can cause anxiety. However, we can say that 1-month post-exposure and completion of PEP, your HIV test is close to being CONCLUSIVE. However, as per international health guidelines, we strongly recommend that the 3-month post-exposure test. We have yet to encounter a patient who tested negative one month after exposure and positive at the 3-month marker. Providing that the patient took their medication properly and there were no other risky behaviors during the period.

It is also prudent that thorough STD testing is done for gonorrhea, chlamydia, and syphilis. These are far more prevalent and may remain undiagnosed if you have no symptoms. Of course, these STDs are treatable and can be cured, compared to HIV. Be sure to consult our doctors if you are worried about other STDs.

Is it worthwhile to undergo PEP treatment every time I have unprotected sex?

PEP is not recommended for persons who are frequently exposed to HIV i.e. if you have unprotected sexual intercourse with an HIV-positive partner or regularly engage in risky sexual behavior. The PEP treatment requires more medications than HIV PrEP (Pre-Exposure Prophylaxis) to block the virus from potentially spreading. As such, PrEP may be a better option for persons who at considerable risk for HIV exposure on a continual basis.

Feel free to speak to us about HIV PrEP if you believe that you are participating in high-risk sexual activity regularly.

There are guidelines, but they are just that. The final decision on whether or not you will be started on PEP is based on what the risk-benefit ratio looks like for you. This discussion will be a formal medical consultation. According to WHO guidelines on HIV PEP, the following individuals are considered eligible:

• If exposure occurred within the past 72 hours and the individual who has been potentially exposed is
  not infected or not known to be infected.
• If broken skin or mucous membrane has been significantly exposed to infectious body fluid and the
  source of the infection is known or HIV status is unknown.

The factors that influence transmission risks are discussed below:

Condoms
The use of a condom helps reduce HIV risk to a certain degree by creating a barrier between your body and the virus.

Partner’s HIV Status
Viral load of HIV positive partner- In the first 4 weeks of HIV infection, the viral load can be extremely high. At this stage, your partner is most likely not aware of the infection. Of course, the higher the virus load, the greater the risk of HIV transmission.

Sexually Transmitted Diseases (STDs)
HIV infection risk increases if you or your partner also test positive for other STDs, such as herpes, chlamydia, gonorrhea, and syphilis.

Where is PEP treatment available?

It is important to note that only a licensed medical practitioner is allowed to prescribe HIV PEP drugs and it is recommended to use the first -line CDC and WHO approved treatment regime for PEP.

We encourage you to speak to your doctor if you would like to find out more about HIV PEP.

What is the difference between PrEP and PEP?

PrEP is taken before potential HIV exposure; PEP is taken after.