HIV Exposure Treatment (PEP) Post Exposure Prophylaxis

WHAT ARE THE SYMPTOMS OF BEING EXPOSED TO HIV (Human Immunodeficiency Virus)?

Since the higher percentage of people being exposed to HIV do not actually become infected, the vast majority of people have no symptoms.

However, some people who are exposed, do become infected. Some of these people report the following symptoms: headache, fever, fatigue, aching muscles, sore throat, swollen lymph nodes, a red rash that doesn’t itch, and ulcers in the mouth, esophagus, or anus. Surprisingly, there are also many people who reported that they experienced no symptoms when they were infected.

WHAT IS THE CAUSE OF EXPOSURE TO HIV?

Most of the time exposure to HIV is a result of having unprotected sex with someone who is infected with HIV—or sharing Intravenous (IV) drugs with someone who is infected with HIV. There are also some people who get infected while working in the medical profession.

The cause of HIV is a virus called the Human Immunodeficiency Virus. This virus slowly attacks an infected person’s immune system. At the beginning of the infection there is often very little change in the person’s outward appearance.

HOW IS POST EXPOSURE PROPHYLAXIS DIAGNOSED?

Post exposure prophylaxis to HIV can be diagnosed by a careful history. Basically, it can be diagnosed when an individual reports a sexual exposure or an exposure to blood, visibly bloody fluids, or other potentially infectious material from an individual known to have HIV or whose HIV status is not known.

A blood test to determine if a person has been infected with HIV should be performed to make certain the person does not already have HIV. Currently, the recommended test is the fourth generation ELISA (enzyme-linked immunosorbent assay). This test is the most desirable because it test two different types of HIV (HIV-1 and HIV-2 ) as well as the p24 HIV antigen.

WHAT ARE POST EXPOSURE PROPHYLAXIS (PEP) TREATMENTS?

* Be aware that the recommended treatments of illnesses are always being improved. This website was last update on 11/1/2024. The best treatment option MIGHT have changed since that time.

The guidelines from the New York Department of Health 2021 are the following.

The first dose of anti-HIV medications (also called Post-Exposure Prophylaxis (PEP)) should ideally be given within 2 hours and no later than 72 hours post-exposure.

1. Tenofovir Disoproxil Fumarate/Emtricitabine plus Raltegravir (also called TDF/FTC plus RAL) or called Truvada plus Isentress. Isentris has a Class C pregnancy rating (possibly bad for fetus).

Or

2. Truvada plus Tivicay [Dolutegravir]) can be given to women who could be pregnant. Trivicay or Dolutegravir both have a class B pregnancy rating {no proven risk}, during first trimester. If a person is not pregnant, birth control should be considered while completing the 28-day PEP regimen.

3. Lamivudine (3TC; Epivir) may be substituted for FTC [Emtricitabine] in either regimen. ­

4. Raltegravir (RAL or Isentress) may be prescribed in the high-dose formulation, but the high-dose formulation should not be given to pregnant patients. The dosage of Isentres varies according to weight and height.

CAUTION:

1. All medication, including medications those that are anti-HIV medications, have a risk of side effects. Most anti-HIV medications can be dangerous if the person has either kidney or liver diminished function.1.

2. Mild side effects are nausea, vomiting, diarrhea, itching, and light skin rash.

3. Possible Severe side effects are a severe skin rash, an anaphylactic allergic reaction (leading to the inability to breathe and subsequent death if not treated rapidly), and Clostridioides difficile infection (C. Diff.) of the colon.

4. Medications such as creams, lotions, and gels should be tested in small dosages in areas of the body that are not easily seen.

Consult “Epocrates.com” for each Specific Medication’s possible “Adverse Reactions.” Side effects are also referred to as “Adverse Reactions.” Epocrates.com will tell you both “common reactions” and “serious reactions.” You will have to create an account, but it is simple, fast, and free.