PEP - Treatment in fear of exposure to HIV

The following is a translation and edit of an article on www.aidsisrael.org.il. For more information see the full article [Hebrew] by clicking here.

PEP

PEP - Treatment given in cases of fear of exposure to the HIV virus. Your condom is torn during sexual intercourse; Are you afraid of being exposed to HIV? There are some things that everyone needs to know:

What is PEP?

*  POST

*  EXPOSURE

*  PROPHYLAXIS - preventive treatment

PEP is a treatment given after exposure to HIV and its goal is to minimize the risk of infection.

Is  PEP  a new invention?

For years, PEP has been used to prevent HIV infection in cases of high-risk exposure. For example, if a medical staff member is exposed to a contagious fluid (for example, stabbed from a syringe containing HIV positive blood), he or she is offered the preventive treatment that should significantly reduce the chances of contracting the virus. This treatment is also offered in hospitals to victims of sexual assault or to partners of HIV positive people if the condom is broken. PEP is actually a drug that is taken for 28 days and is based on the combined drug therapy that people living with HIV take throughout their lives.

In what situations should I consider PEP ?

If one of the following conditions occurs:

1. Almost certain exposure to the virus, for example, you are HIV negative and in a relationship with someone who is positive. Although you are always careful about protected sex - something happens and the condom breaks at the time of penetration.

2. Possible exposure to the virus, such as having unprotected sex with a partner whose HIV status is unknown, and a condom rupture during penetration.

3. Having unprotected sex that involves penetration with a partner whose HIV status is unknown or known to be positive.

Some clear cases in which treatment is recommended:

1. A needle stabbing from a person living with HIV (mainly occupational exposure).
2. People who have been penetrated without a condom by a person living with HIV and whose therapeutic status is unknown.  
3. Victims of sexual assault. (If a call to the ER is made up to 72 hours).

How do you get and who decides on it?

If you are concerned about HIV, contact the emergency room of one of the listed hospitals below as soon as possible (and no later than 72 hours after exposure). Treatment can be requested 24 hours a day, 7 days a week.

Where can I get the treatment?

In each of the following seven emergency rooms (24 hours a day, 7 days a week):

• Soroka, Beer Sheva
• Kaplan, Rehovot
• Hadassah Ein Karem, Jerusalem
• Sheba, Tel Hashomer
• Ichilov, Tel Aviv
• Meir, Kfar Saba
• Rambam Medical Center, Haifa

Remember: the treatment is not given to anyone who wants it, and the decision is made by the doctor in the emergency room. The doctor will decide whether or not to prescribe the treatment, only after consulting an infectious disease specialist or an HIV doctor from the hospital's AIDS center, since this is a treatment with rare but life-threatening side effects, the doctor will try to see if the risk of infection in your case justifies the chances The doctor will ask you some questions related to your sex habits and the last time you have unprotected sex.

Can I go directly to the emergency room or need a referral?

A visit to the hospital must be paid by a fee, unless there is a commitment from the health fund (hitchayvut/Form 17), or in cases defined in advance by the Ministry of Health and in the regulations of the health funds. HIV prevention is not one of these cases, so in order to be exempt from a screening visit, you must have a hitchayvut. How do you do this? One way is to visit a family doctor and ask for a referral to the ER. It may be a cumbersome way of scheduling or trying to get into a doctor without a queue because of an emergency, and time is pressing. The simplest and fastest way would be to call the HMO call center and ask to speak to the nurses' center. If the nurse at the center approves the need for an emergency appointment, the telephone call is recorded on the computer and is considered according to the fund's regulations as a liability of the fund for all intents and purposes. In some cases the nurse may require you to visit your GP. In such a situation, you must clarify the urgency of the matter and insist on receiving a referral from the call center.

In any case, remember: Arriving at the ER without a commitment from a doctor or a nurses' center will cost you NIS 715, even if the visit is medically justified.

What happens to a caller when he arrives at the ER?

A number of tests are performed at the ER. First, an HIV test that checks whether there has been past infection (and then any unnecessary preventive treatment). In addition, a blood count is performed and a liver and kidney function test is performed to determine a health condition that does not allow taking the treatment. In addition, in case of exposure to sexual relations, antibiotic treatment was provided to cover other sexually transmitted diseases (gonorrhoea and chlamydia). At the end of the tests, and after the consultation of the emergency doctor with a physician aids are given in sorting out several doses of treatment for the next day or two. During the course of the treatment, the person is instructed to perform additional tests, the most important of which is, of course, HIV testing after three weeks of treatment. Which prevents, to ensure that no adhesion occurred.

What would they ask me in the emergency room?

The questions that the doctor will ask you in the emergency room can be very personal and cause a feeling of discomfort. You will be asked to talk about the partner with unprotected sex, you will be asked about the sexual act, when was, what included what was your role in sex and whether there was ejaculation inside or outside. Remember that the doctor asks for all this information not to satisfy his curiosity but to make the right decision about your health. In any case, all the information you tell your doctor needs medical confidentiality so that you can be calm. The more accurate information you provide, the more appropriate a decision can be made by your doctor regarding the need for preventive care and its composition.

So take or not take?

Whether to take or not to take lies in the benefit of treatment versus its risks. Treatment is not easy in many cases and sometimes even life-threatening. Another important fact is that the side effects of the treatment may be difficult. Usually more severe than the side effects experienced by people living with HIV and taking the treatment for many years. For these reasons, complex therapeutic protocols have been written that weigh the risk of infection compared with the risk of side effects, according to which the AIDS doctors decide whether to give the treatment or not.

When should I seek treatment?

The faster the better! The efficacy of the treatment depends on the time that has passed since the exposure: the closer the treatment is to the time of exposure, the more effective it is. If 72 hours have elapsed since the exposure, PEP will not be given in any case because treatment is no longer effective.

It has recently been shown that taking the treatment more than 48 hours after exposure reduces its effectiveness significantly, so in situations where PEP is recommended, this should be done as soon as possible !!!

Some things to know about  PEP :

• PEP is not a "day after" pill and is definitely not a substitute for condom use.
• Treatment reduces the chances of HIV infection but is not 100% effective.
• Treatment must commence as soon as possible as of the date of exposure, and in any event not later than 72 hours from the moment the incident occurred.
• The treatment is not given to anyone who asks, and in any case, it is possible to receive it only in emergency rooms with the instruction of a specialist.
• Treatment is based on some of the combined drug therapy taken by people living with HIV
• Treatment has short- and long-term side effects. Sometimes these are serious phenomena. (And therefore, as noted, can not be given to any person who requests it and under the instruction of a specialist doctor only).
• So now I know there is a PEP, why should I continue using the condom?

Well, simply because PEP is not a protective measure and it certainly is not a substitute for a condom. This is not a "day after" pill, but a complex drug treatment with side effects that can be determined by an emergency room doctor. In the case of PEP, the doctor will decide for you. They have the full professional authority to refuse you.