In my last 20 years of work as a HIV specialist one of the most rewarding aspect has been to help and provide Post Exposure Prophylaxis (PEP) for HIV to doctors, health care workers and general population if they had accidental exposure to HIV. Usually exposure to HIV in non-medical setting happens while having casual penetrative sex of any kind without use of condoms. When such exposure occurs, there are various interventions which can prevent an exposed person from getting infected with HIV. In this article we will cover unique aspects of PEP for HIV.
First step in managing exposure is to get in touch with an experienced HIV specialist. We should treat this as a medical emergency and treatment should begin at the earliest, preferably within 2 hrs. All details of incidents should be shared with HIV specialist as soon as possible. We then carry out a detailed assessment of exposure incident and thorough evaluation of source person. If source patient’s status regarding HIV is unknown, we carry the relevant test. If results are not immediately available or results are awaited and exposure has occurred, then the best strategy is to begin prophylaxis immediately and either discontinue or change the regimen when results of the test are available. In case source patient is already HIV infected then all information about patient which includes time since patient is infected, CD4+ counts, viral load assays and detailed history about past and current antiretroviral therapy are obtained.
As of today, there are various regimens available for PEP for HIV. We select a particular PEP regimen after a detailed assessment of exposure. We counsel exposed individually on seriousness of exposure, effectiveness of PEP regimen, need for 100% adherence and regular follow up for management of toxicities if encountered. The optimal course of treatment is 4 weeks.
After starting medicines for PEP next step is follow up. Person receiving prophylaxis should follow up with the clinician at least once in a week. I advise them not to donate blood, semen or organs/tissues and abstain from sexual intercourse. In case sexual intercourse is undertaken by an exposed person, then a latex condom to be used consistently. In addition, women should not breast-feed their infants during the follow-up period. We do serological tests for HIV for an exposed person at baseline, 6 weeks, 3 months and 6 months with proper pretest and post test counseling.
We see it most of the times that PEP for HIV is frequently advised by doctors who are not very familiar with all the aspects of this subject. An experienced specialist is only suited to probe whether an exposure has occurred and then select right medicines to be administered.
There are thousands of stories of people who had taken PEP for HIV from us. It includes people from all sections of society. I also run a telephonic helpline to provide PEP to Health Care Workers following exposure to HIV in medical settings. We receive 3 to 5 consultation calls for PEP for HIV every week. If you unfortunately get exposed to HIV, then please get in touch with us on our consultation icon or send a mail id provided on the website, we will immediately do an emergency telephonic consultation for you and will provide PEP for HIV.
In the next article I will share information about availability of best HIV treatment in India at par with the best centers of the world.
Yours, truly
Dr Alok
