HIV PEP (POST-EXPOSURE

PROPHYLAXIS)Dr. Dino SgarabottoMalattie Infettive e Tropicali

Azienda Ospedaliera di Padova

WHAT IS HIV- PEP?• HIV is the human immunodeficiency virus. It is the

virus that can lead to acquired immune deficiency syndrome, or AIDS.

• PEP involves taking anti-HIV drugs as soon as possible after having been exposed

• To be effective, PEP must begin within 72 hours after exposure, before the virus has the time rapidly replicate in your body

• PEP consists of 2-3 anti-HIV medications taken every day for 1 month

PEP means Post-Exposure Prophylaxis

• Prophylaxis means disease prevention• PEP involves taking anti-HIV drugs as soon as

possible after you may have been exposed to HIV to try to reduce the chance of becoming HIV positive; occupational PEP (health-care setting) and non-occupational PEP (condom breakage, sexual assault, etc.)

• The medications may have side effects that can make it difficult to finish the program. PEP is not 100% effective; it does not guarantee that someone exposed to HIV will not become infected with HIV.

Who needs PEP?• PEP is usually used for anyone who may have been

exposed to HIV.• Healthcare workers have the greatest risk. They

can be exposed to HIV by:– Needle sticks or cuts– Getting blood or other body fluids in their eyes or

mouth– Getting blood or other body fluids on their skin when it

is scraped, or affected by dermatitis• The risk of HIV transmission in these ways is low—

less than 1% for each exposure

Why can’t PEP therapy be taken after 72 hours from the point of exposure?

• HIV grows faster and faster once it enters your body.

• If you start taking PEP more than 72 hours after exposure, the meds can’t keep up, and research has shown that PEP has little or no effect in preventing HIV infection after the 72-hour mark.

• Better if PEP starts within 6 hours from injury

Different kind of exposure• Exposure to a large amount of blood.• Blood came in contact with cuts or open sores on the

skin.• Blood was visible on a needle that stuck someone.• Exposure to blood from someone who has a high viral

load (a large amount of virus in the blood).• For serious exposures, it is recommended

using a combination of three drugs for four weeks. For less serious exposure, the guidelines recommend treatment with two drugs for four weeks: AZT and 3TC

Two drug regimens • AZT and 3TC: Zidovudine 300 mg BID +

Lamivudine 150 mg BID or Combivir 1 Tab BID

• FTC and TDF: Emtricitabine 200 mg OD + Tenofovir 300 mg OD or Truvada 1 Tab OD

+

Three drug regimens • Combivir BID or Truvada OD• Associated with:– Lopinavir 400 mg and Ritonavir 100 mg BID:

Kaletra 2 tabs BIDor

– Atazanavir 300 mg OD + Ritonavir 100 mg OD: Reyataz 300 mg OD and Norvir 100 mg OD

Combivir/Kaletra

+

BD: twice a day regimen; 6 Tabs a day

Truvada/Reyataz/Norvir

OD: once a day regimen; 3 Tabs a day

WHAT ARE THE SIDE EFFECTS?• The most common side effects from PEP

medications are nausea and generally not feeling well.

• Other possible side effects include headaches, fatigue, vomiting and diarrhea.

Prevention strategies• Health care workers should assume that the blood

and other body fluids from all patients are potentially infectious. They should therefore follow infection control precautions at all times.

• Routinely using barriers (such as gloves and/ or goggles) when anticipating contact with blood or body fluids,

• Immediately washing hands and other skin surfaces after contact with blood or body fluids, and

• Carefully handling and disposing of sharp instruments during and after use.

Gloves and goggles (glasses)

Disposal containers• Safety devices have been developed to help

prevent needle-stick injuries. If used properly, these types of devices may reduce the risk of exposure to HIV.

• Many percutaneous injuries, such as needle-sticks and cuts, are related to sharps disposal. Strategies for safer disposal, including safer design of disposal containers and placement of containers, are being developed.

Don’t recap needles of used syringes!

Use the disposal containers!

or

Conclusions• Post-exposure prophylaxis (PEP) is the use of

anti-HIV drugs as soon as possible after exposure to HIV, to prevent HIV infection. PEP can reduce the rate of infection in health care workers exposed to HIV by 79%.

• The benefits of PEP for non-occupational exposure have not been proven. This use of PEP is controversial because some people fear it will encourage unsafe behaviors.

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