Post-exposure prophylaxis (PEP)

Over the past several years, research into the field of prophylaxis for high-risk sexual contacts has been/ and is still under investigation. For example, in those couples where one partner is infected (and the other is not – called a sero-discordant couple), if there is a sexual accident; the condom breaks, the condom remains in the vagina or rectum, unprotected penetration occurs for other reasons (drug or alcohol related) – a preventive treatment may be envisaged. It is important to stress that this is not the "morning-after pill". Far from it!! This is an area of research wherein it is difficult to assess the efficacy of such preventive treatments. The theory is based on and extrapolated from preventive approaches used with success in occupational and maternal-fetal transmission cases (needlestick and delivery risks). Such treatment plans suggest a potential benefit…there is no guarantee!! Prevention remains your best protection against the transmission of HIV/AIDS.

If you have been exposed/potentially exposed to HIV... What to do?

• Consult a physician familiar with PEP protocols;
• Remember that timing is critical when considering the use of PEP treatment – ideally the sooner you consult, the better. The sooner medications are started, the better. Most clinicians are in agreement that when greater than 72 hours has elapsed since sexual contact – the benefits of a prophylactic treatment are likely lost. The best scenario is when consultation occurs immediately after the accident/event or within 24 hours;
• Your physician will evaluate your level of risk, your ability to take and tolerate medications and when appropriate will recommend a triple-therapy. The decision to ultimately take medications remains your own. Your physician will assist you in arriving at the best situation for you;
• Treatment is for 4 weeks. Again, this is definitely not the morning-after pill;
• Strict follow-up is important during and after the treatment, so as to ensure that side-effects to medications remain manageable. Follow-up and blood tests during the treatment period are critical in the prevention of serious medication related side effects;
• An HIV test will be done on the day of consultation, at 1 month and at 3 months time. This so as to confirm your HIV status at the beginning, during treatment and once the test eclipse period has passed;
• Ideally, the more you know about your partner (medication history, laboratory results, successes or failures with respect to treatment) – the better in tailoring the PEP treatment for success in the prevention of infection by HIV.