Post-Exposure Treatment for HIV

Post-Exposure Treatment for HIV

Disease prevention, or, 'Prophylaxis,' (PEP) involves taking antiretroviral medications (ARV's) as quickly as possible once you have been exposed to the HIV virus with the hope that your exposure will not lead to an HIV infection. ARV medications are available only by prescription, and PEP needs to start as quickly as possible once you have been exposed to the HIV virus; no more than seventy-hours afterward. Treatment may involve the use of two or three ARV's over a period of four weeks.

Healthcare workers, Police, and others have used Prophylaxis since 1996 for exposure to the HIV virus, taking ARV's within a few hours after exposure. They are usually exposed through accidentally sticking themselves with a needle containing HIV-infected blood. PEP has reduced the rate of HIV infection among these workers by seventy-nine percent, but some of them still become HIV-positive.

The Centers for Disease Control reviewed information related to PEP in 2005, concluding that it should be available to other people who have been exposed to the HIV virus, not necessarily just those in work-related situations. Infants exposed to HIV through breast milk, people exposed when a condom breaks during sexual activity, and persons who share needles are also exposed. The study of PEP involved four-hundred cases of potential sexual exposure to HIV and PEP; of these, no one became infected with the HIV virus.

Workers who are exposed to the HIV virus are often exposed only once, while others who are exposed to the virus may be exposed because of unsafe behaviors which can happen multiple times. There is a debate over whether PEP should be offered to people whose behaviors present them with repeated risk of exposure to the HIV virus, the reason being that it would encourage their behavior. It is unknown how soon after exposure to HIV a person has to start PEP, and it involves several medications, taken several times each day - at a cost of between $600 and $1,000. A missed dose increases the chance that the person will develop the HIV virus, as well as increasing the chance that the virus itself will develop resistance to the medications. The medications themselves have some serious side-effects, causing forty-percent of the people who have taken them to discontinue taking them.

Despite these facts, there is a growing interest in PEP for the HIV virus in persons who have been exposed in non-occupational circumstances. Programs related to non-occupational HIV exposure often include counseling with the aim of informing and encouraging people to avoid exposure to the HIV virus in the first place. The side-effects of PEP treatment include nausea and a general sense of, 'not feeling well.' There are other potential side-effects such as, vomiting, diarrhea, headaches and fatigue.

The medications involved in PEP, and how they are taken, depend on the exposure to the HIV virus. There are some different situations that are taken into consideration where PEP is concerned such as whether blood has come into contact with either open sores or cuts on the skin, or whether blood was visible on a needle that has stuck a person. Other considerations are whether large amounts of blood were involved in the exposure, or whether the blood came from another person who has a large amount of the HIV virus in their system.

A more serious exposure to HIV involves three ARV's over a four week period of time, as recommended by the U.S. Public Health Service. If the exposure is less serious, their guidelines suggest using AZT and 3TC for four weeks. The Centers for Disease Control presented a warning against using Nevirapine for PEP in January of 2001 due to the risk for liver damage

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