Post-exposure prophylaxis for HIV in Singapore consists of medications taken for about a month. It can reduce the risk of becoming HIV-positive after exposure.
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Human immunodeficiency virus, or HIV, is one of the most feared infections by many people. This is because the infection can’t be cured; it requires lifelong medication for management, and is fatal if untreated. Most people are very motivated to avoid this infection.
HIV is transmitted in bodily fluids, including semen, pre-ejaculate, vaginal fluid, and blood. Exposure to HIV can occur during unprotected sex, injection drug use, transfusion of unscreened blood, or as a healthcare worker who is stuck by a contaminated needle.
When someone has had a known exposure to HIV, there is a method of preventing them from developing the lifelong infection. This is called post-exposure prophylaxis, or PEP. The most common settings for it are in healthcare workers stuck by a contaminated needle, people who are forced to have sex against their will, and those who have consensual sex or share drugs with someone they later find out is HIV-positive.
Testing Before Post-Exposure Prophylaxis
After an exposure, HIV testing may be needed. The source, from whom the potentially contaminated blood or other fluids came, may need to be tested for HIV, unless their status is already known. The patient, who has been exposed to the blood or fluids, may also need to be tested, unless they have been recently tested for HIV.
Keep in mind that the HIV test doesn’t become positive for three months after exposure in those who develop the infection. This is how long it takes for the virus to replicate within the body to high enough levels, and for the body to respond in such a way, that the test can detect the infection. This has several implications. The source of the blood or body fluids may test negative, but if this person has a pattern of high-risk behavior, it’s possible that they’ve been exposed to HIV and have the infection but the test isn’t positive yet. Therefore, post-exposure prophylaxis may be appropriate even if the source’s HIV test is negative.
Also, the current exposure was too recent to show up on the patient’s HIV test. This test will not reveal whether or not the patient has gotten the infection from the exposure; it will reveal whether or not the patient already had the infection and didn’t know about it.
Post-Exposure Prophylaxis Regimen
Assuming the source is positive and the patient is negative, then post-exposure prophylaxis can begin. This consists of two or three antiretroviral (anti-HIV) medications, which are taken for about a month. These prevent the virus from replicating, which can prevent the infection from taking hold in the body.
PEP must be started within three days of the exposure to be effective at all. If it’s been longer than three days, PEP will not reduce the risk of the patient becoming HIV-positive.
PEP is an appropriate regimen for those who have had a single known or likely exposure to HIV. It’s not appropriate for those who have ongoing exposure, such as frequent unprotected sex or injection drug use.
References
HIV PEP at Shim Clinic, Singapore