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PEP – Post Exposure Prophylaxis

The consistent and correct use of condoms and condom-compatible lube remains the best prevention strategy against the transmission of HIV and other Sexually Transmitted Infections (STIs). However, in reality, this is not always possible (given issues of condom fatigue, condom failure, being in the heat of the moment, and concurrent drug use etc.). As such, other alternatives are available, such as Post Exposure Prophylaxis (PEP).

What is PEP?
PEP is a short course of anti-retroviral medication that is taken soon after exposure to the HI Virus in order to block or reduces the chances of contracting HIV.

Who is PEP for?
PEP is available to any person following either:

  • Intentional exposure (e.g. unprotected sex, sharing injecting equipment, etc.),
  • Accidental exposure (e.g. condom failure), or
  • Forced exposure (e.g. sexual abuse, sexual assault or rape)

Under which circumstances can PEP be considered?
PEP may be considered where there is potential risk that HIV infected bodily fluids (i.e. blood, semen, or vaginal fluids) have entered the bloodstream through direct contact, including any of the following:

  • Anal or vaginal sex without a condom
  • Anal or vaginal sex where the condom slipped off or broke
  • Sharing injecting equipment
  • In cases where the degree of risk is either:
    • Suspected to be high (where the other person is suspected to be HIV positive)
    • Known to be high (where it is known that the other person is HIV positive), or
    • Uncertain (it is not known whether the other person is HIV positive or not)

How long should PEP be taken for?
The PEP regimen is taken for a period of 4 weeks (or 30 days).

When should I take PEP?
Depending on the degree of risk, PEP should be started within 72 hours after potential exposure to the HI Virus. To ensure PEP is most effective, it should be started within 24 hours. It is therefore important that YOU ACT FAST!

What does taking PEP involve?
Following exposure, the first step is to visit a clinic or health care facility that provides PEP. Once there, you will be assessed to determine the nature and level of your risk. Following this initial assessment, a HIV rapid test will be conducted, and PEP may or may not be prescribed, depending on the result of the test. If the test result is negative, PEP will be prescribed. The full course of 4 weeks will have to be completed. In case of a positive test result bloods will have to be drawn for a full blood analysis.

PEP treatment, if recommended, is a combination of two or three anti-retroviral medications:

  • Lamzid (AZT + 3TC) 1 tablet twice a day after a meal.
  • Aluvia 2 tablets twice a day after a meal.
  • D4T 30mg twice a day + 3TC 150mg twice a day + Aluvia 2 tablets twice a day after meals.

For PEP to work, you will need to take the drugs exactly as prescribed for the entire duration of the treatment period (i.e. 4 weeks). If you do not take the drugs as prescribed, the virus may become resistant, and the treatment may fail.

How does PEP work?
There is evidence that the HI Virus may take a few days from the time of exposure to establish itself in the body. HIV first enters some cells, then copies itself, and then begins to spread to other cells. PEP medication is designed to prevent HIV from multiplying in those first cells. Without being able to produce more HIV, the cells then die off naturally within a short time and risk of infection can be avoided or reduced.

What are the side effects of PEP drugs?
PEP medication consists of powerful drugs that can cause serious side effects, including any of the following reported symptoms:

  • Abdominal pain
  • Diarrhoea
  • Nausea and vomiting
  • Headaches

What about sex while on PEP?
You can still have sex, but it is very important that you do not place yourself or your sexual partner at further risk if HIV transmission by having unprotected sex or sharing injecting equipment while taking PEP.

What about other drugs while on PEP?
PEP medications can affect the way other drugs (prescription and non-prescription) work in the body. It is important that you discuss with your medical advisor any drugs that you are currently taking or intend to take in the future.

What happens after taking PEP?
PEP can significantly reduce the risk of HIV infection, but there is no absolute guarantee. Studies have shown that there is a 80% or more chance of not contracting HIV when PEP was taken in time. PEP guidelines recommend that you be tested for HIV before starting PEP and tested again three and six months afterwards. Counselling will be provided before and after each test.

Quick Facts about PEP

  • PEP is an anti-HIV drug
  • PEP is taken for 4 weeks (30 days)
  • PEP should be taken within 72 hours of exposure
  • PEP should be taken exactly as prescribed
  • PEP has side-effects
  • PEP is not a fool proof form of HIV prevention
  • PEP is not a ‘morning-after’ pill
  • PEP should not replace other safer sex strategies like correct and consistent condom use

Help is available!
For more information on PEP or to access PEP within 72 hours, please do not hesitate to contact the OUT Clinic in Pretoria (South Africa). Call 012 430 3272 / 0860 688 688.