PEP (Post-Exposure Prophylaxis) in HIV.
First of all we should know what PEP is?
PEP stands for Post-Exposure Prophylaxis. It means things to be done if anyone gets exposed to HIV. PEP consists of a combination of ARV (Anti-Retroviral) drugs which is given for a complete duration of 28 Days.
If any person (male/female/transgender) comes in contact with a person who might be having risk of HIV infection, then in such case the former have chance of getting HIV infection too. Such person falls in the category of clients who should start PEP depending upon the risk of transmission and mode of exposure.
What Are the Modes of Exposure?
What to “DO” in such circumstances?
Previously there were no options available for persons who by any means gets exposed to HIV.
But due to recent advances, now we have a set of medicines available which are very much beneficial in such conditions.
So any person getting into such circumstances knowingly or unknowingly SHOULD visit a HIV Specialist for management as soon as possible (it should be within 72 Hours), because the PEP is beneficial only if started early (maximum within 72 Hours).
By doing this we can PREVENT patients from getting HIV infection.
Always Remember Prevention Is Better Than Cure.
When you are potentially exposed to HIV, and if there is a way to prevent from getting infected, you will seek to perform it. One such procedure is Post Exposure Prophylaxis (PEP) which must be initiated within 72 hours of possible exposure to HIV.
What is PEP meant for?
The Human immune deficiency virus causes HIV infection that affects the immune system and is considered to be one of the deadly forms of infections. This virus spreads through bodily fluids such as blood, semen, vaginal fluids and breast milk. There are chances of encountering the infection under the circumstances such as having sexual intercourse or sharing needles with an infected person by accident. In such a case, PEP (Post Exposure Prophylaxis) can come to your aid in preventing the infection.
The medical term PEP refers to the intake of ARV or antiretroviral medicines after being exposed to the human immunodeficiency virus. To be more specific, PEP is a short-term antiretroviral treatment that works towards reducing the symptoms and likelihood of the HIV infection after being exposed to it.
Who should opt for PEP treatment?
PEP can be ideal for everyone who comes in contact with the HIV and is an HIV negative. Whether one is exposed to HIV through a needle stick injury during his/her work as a health care professional, or whether it’s unprotected sex that has exposed one to HIV, or the sharing of used needles or through sexual assault, opting for the PEP can be the next best step as it is particularly meant for emergency situations.
When and how long PEP can be taken?
Are there any side-effects of taking PEP?
When opting for PEP treatment, some people may experience a few side effects due to it, which varies from person to person, such as vomiting, nausea, headaches, diarrhea, fatigue, etc. However, none of the side effects are life-threatening and can be easily treated. Often, it is due to the reaction of the PEP medications with other drugs that one is taking at the same time that the side-effects start showing. Moreover, as PEP can potentially prevent HIV infection, this benefit certainly outweighs the inconvenience caused as side effects.
PEP is considered to be one of the most effective and promising treatments available for preventing HIV infection if taken correctly and within the certain time duration. In case one thinks he or she has been exposed to HIV somehow, talking to a health care professional regarding PEP becomes crucial.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Pre-exposure prophylaxis is a treatment method for people who do not have the HIV infection but who might be facing a considerable risk of contacting the disease. It is done by taking one pill daily. The pill comprises of two medicines i.e. tenofovir and emtricitabine. These two are combined with other drugs in order to treat HIV. When a person is exposed to HIV, be it through sexual intercourse or shared needles, these drugs help in stopping the infection from reaching an advanced stage.
Dosage and use
When the drug is consumed on a regular basis, pre-exposure prophylaxis has been observed to decrease the risk of HIV infection in individuals with increased risk by up to 92%. Pre-exposure prophylaxis is not as effective when not taken on a consistent basis.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Post exposure prophylaxis(PEP) is a systemic treatment in which we can save life of a patient and help him to prevent from being HIV positive. Any possible exposure which will lead to HIV infection including sexual intercourse with sex worker and during that condom get burst or having intimate massage at massage parlor, the person is exposed to direct contact that can lead to the possible exposure to HIV.
What is post-exposure prophylaxis?
With PEP, an HIV-negative person who may have been exposed to HIV takes anti-HIV drugs prescribed by a doctor to prevent infection. These are the same drugs that people living with HIV take. PEP involves taking two or three of these drugs for a period of one month. To effectively reduce a person’s risk of becoming HIV-positive, PEP must be taken within 72 hours of possible exposure to HIV but ideally as early as possible.
In the world of PEP, exposure to HIV is often divided into two categories: occupational exposure and non-occupational exposure. “Occupational” exposure refers to exposure to HIV at work, in a healthcare setting. For example, a healthcare provider could be exposed to HIV through a needlestick injury at work. “Non-occupational” exposure refers to exposure to HIV through sex or drug use, for example, when a person shares a needle or has sex without a condom.
What is the rationale for PEP?
In the first one to three days following exposure to HIV, there is a ‘window of opportunity’ when taking PEP might prevent an HIV infection from occurring.1 During this ‘window of opportunity,’ the virus is busy infecting cells at the site of exposure (such as in the anus, penis or vagina). Once the virus is inside a cell, it starts replicating to produce more HIV (also known as virions). After a few days, these new HIV virions start to spread throughout the body; once this happens, infection is permanent. The theory is that if PEP is given to a person early enough, it can stop the virus from replicating at the initial site of exposure, preventing virions from spreading throughout the body – stopping the infection from becoming permanent. The cells that initially became infected would eventually die out and the virus would not be able to replicate.
What is the evidence on PEP?
There is some evidence that suggests that providing PEP after a potential exposure to HIV can help reduce a person’s risk of HIV infection. However, we also know that PEP is not 100% effective, meaning that it will not prevent all HIV infections.
Learn more about the evidence on PEP
What does someone need to know to access PEP?
People at risk need to know that PEP exists. If people are unaware of PEP, they won’t know that PEP is an option in the event of a high-risk behaviour that could result in being exposed to HIV. Very little research has been done to determine how many people are aware of PEP; however, based on the research that has been done, it seems that only a small proportion of gay and heterosexual men and women, even in cities with well-established PEP programs, are aware of PEP.9,10,11,12
People at risk need to know that time is of the essence. The later someone starts PEP, the less likely it is to prevent HIV infection. The best time to start PEP is immediately after exposure. However, PEP has some ability to prevent HIV infection up to 72 hours after infection.
People at risk need to know where to go. PEP must be prescribed by a doctor. Since time is of the essence, people need to be able to access services that are always open, such as emergency rooms. As a service provider, it may be important for you to know if there is a physician or healthcare facility in your area willing to prescribe PEP. If there isn’t, perhaps your organization can inform local clinicians of PEP and push for access to PEP for your clients.
Anyone accessing PEP will be tested for HIV. PEP is used to prevent HIV, not to treat it. People who go to a healthcare facility for PEP will be tested for HIV. They will still be prescribed PEP while the test results are pending; however, if the result is positive, PEP may either be discontinued or the anti-HIV drugs may be changed to HAART (highly active antiretroviral therapy) to treat the person’s HIV infection.
PEP can be costly and it may have to be paid for out of pocket. The cost of a full course of PEP is approximately $1100 to $1500. PEP may be covered by some private insurance plans and some public health insurance plans, depending on the province and the nature of the exposure. However, many at-risk individuals may not have access to any drug coverage and may not be able to afford it. There may be a need for advocacy in your area or province to fight for universal access to PEP.
People on PEP may experience side effects. Depending on the anti-HIV drugs prescribed, people may experience side effects from PEP, such as fatigue, nausea or diarrhea. This can cause people to stop taking their PEP drugs as prescribed, which can decrease the ability of the medications to prevent HIV infection and increase the likelihood of being infected with a drug-resistant strain of HIV.
People on PEP have to be monitored by a doctor. Testing for toxicity will be required to make sure the drugs are not causing harm to the body. The type of tests may differ depending on the anti-HIV drugs that are prescribed but would likely include liver and kidney tests.
PEP can fail to prevent HIV infection if someone doesn’t take the anti-HIV drugs as prescribed. Taking the anti-HIV drugs exactly as prescribed (also known as adherence) is central to the success of PEP. If someone doesn’t take their PEP as prescribed, then HIV infection could occur. There are two issues with adherence:
Some people might start PEP but stop using it early (before the four weeks are over). In research studies 24% to 78% of people who started PEP stopped taking it early.13
Some people may not take their PEP exactly as prescribed. For example, some people may occasionally forget doses, or take only every second dose.
Drug resistance can develop if a person doesn’t take the anti-HIV drugs as prescribed. If a person becomes HIV-positive due to non-adherence, they may develop drug resistance. When someone does not take PEP as prescribed, the amount of anti-HIV drugs in the blood can be too low to suppress the HIV, which can allow the virus to evolve and develop resistance. It is important to understand that infection with a drug-resistant strain of HIV limits a person’s future treatment options. If a person with a drug-resistant strain of HIV subsequently infects someone else with HIV, drug resistance spreads within the community.
Community agencies can provide adherence support for people on PEP by providing ongoing consultation and encouragement to help people take PEP exactly as prescribed and to complete their treatment.
PEP may fail to prevent HIV infection due to drug resistance. If a person is exposed to a drug-resistant strain of HIV and the person is prescribed the drug they are resistant to, as part of their PEP regime, then PEP may fail to prevent HIV infection. Unfortunately, there is no way to know within the first one to three days if someone has been exposed to drug-resistant HIV.
Teeth cleaning is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities (dental caries), gingivitis, and periodontal disease. People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened deposits (tartar) not removed by routine cleaning. Those with dentures and natural teeth may supplement their cleaning with a denture cleaner.
Careful and frequent brushing with a toothbrush helps to prevent build-up of plaque bacteria on the teeth. Electric toothbrushes were developed, and initially recommended for people with strength or dexterity problems in their hands, but they have come into widespread general use. The effectiveness of electric toothbrushes at reducing plaque formation and gingivitis is superior for reducing plaque and gingivitis to that of conventional manual toothbrushes
In addition to brushing, cleaning between teeth may help to prevent build-up of plaque bacteria on the teeth. This may be done with dental floss or interdental brushes.
80% of cavities occur in the grooves, or pits and fissures, of the chewing surfaces of the teeth, however, there is no evidence currently showing that normal at-home flossing reduces the risk of cavities in these areas.
Special appliances or tools may be used to supplement toothbrushing and interdental cleaning. These include special toothpicks, oral irrigators, and other devices. A 2015 Cochrane review found insufficient evidence to determine whether the interdental brushing decreases the levels of plaque when compared to flossing.
Teeth can be cleaned by scrubbing with a twig instead of a toothbrush. Plant sap in the twig takes the place of toothpaste. In many parts of the world teeth cleaning twigs are used. In the Muslim world the miswak or siwak is made from twigs or roots that are said to have an antiseptic effect when used for cleaning teeth.
Professional teeth cleaning
Dental hygienist polishing a person's teeth
Teeth cleaning (also known as prophylaxis, literally a preventive treatment of a disease) is a procedure for the removal of tartar(mineralized plaque) that may develop even with careful brushing and flossing, especially in areas that are difficult to reach in routine toothbrushing. It is often done by a dental hygienist. Professional cleaning includes tooth scaling and tooth polishing and debridement if too much tartar has accumulated. This involves the use of various instruments or devices to loosen and remove deposits from the teeth.
As to the frequency of cleaning, research on this matter is inconclusive. That is, it has neither been shown that more frequent cleaning leads to better outcomes nor that it does not. A review of the research literature on the question concluded "[t]he research evidence is not of sufficient quality to reach any conclusions regarding the beneficial and adverse effects of routine scaling and polishing for periodontal health and regarding the effects of providing this intervention at different time intervals". Thus, any general recommendation for a frequency of routine cleaning (e.g. every six months, every year) has no empirical basis. Moreover, as economists have pointed out, private dentists (or other dental professionals) have an economic incentive to recommend frequent cleaning, because it increases their revenues.
Most dental hygienists recommend having the teeth professionally cleaned every six months. More frequent cleaning and examination may be necessary during treatment of dental and other oral disorders. Routine examination of the teeth is recommended at least every year. This may include yearly, select dental X-rays. See also dental plaque identification procedure and removal.
Good oral hygiene helps to prevent cavities, tartar build-up, and gum disease.
Overly vigorous or incorrectly performed brushing or flossing may cause injury to the gingiva (gums). Improper or over-vigorous brushing may cause sore gums, damage to tooth enamel, gingivitis, and bleeding gums. Dentists and dental hygienists can instruct and demonstrate proper brushing or flossing techniques.