HIV testing in pregnancy should be done early so as standard care can be taken for the pregnant women. The HIV testing must be repeated in the third trimester, usually before 36 weeks of gestation. This should be done in women with HIV seronegative and also in pregnant women who are at a high risk of developing HIV infection.
Expedited HIV tests should be performed at the time of delivery and labor and this is a must in women who have not been documented for HIV. The results of the test should be available within an hour of the test and the testing should be available 24 hours. In case the results are positive then, infant postnatal antiretroviral and intrapartum drug prophylaxis should be started immediately.
Women who have not been able to get tested for HIV at the time of labor and delivery are suggested expedited screening for HIV. Their screening can be done immediately postpartum or their babies should undergo screening. In case the infant and mother, both are positive, then infant antiretroviral drug prophylaxis should be started immediately. These mothers should avoid breastfeeding their babies, until the supplemental HIV tests are negative. In infants with positive HIV, prophylaxis should be discontinued and antiretroviral drug therapy should be started.
In case of acute HIV infection during pregnancy, that is in the intrapartum period, or during breastfeeding, initial testing can be performed with an antigen/antibody combination immunoassay. If the supplemental test is negative, then an additional test which is the virologic test (DNA, RNA) are necessary for the diagnosis of the HIV infection. If the mother is HIV positive, then this information must be documented in the infant's medical record and also communicated to the infant's care provider.
The knowledge of an antenatal maternal HIV infection allows the:
What is PEP?
PEP stands for POST EXPOSURE PROPHYLAXIS that is indicated for HIV infected persons,started within 72 hours of possible exposure to prevent from becoming HIV positive.
What are indications of PEP? When to start PEP treatment?
After the exposure to HIV infection, PEP treatment should be started by consulting HIV specialist, within the 72 hours of exposure.
What is the success rate of PEP treatment?
Theoretically it is 98% but practically if started as soon as possible within 72 hours of possible exposure, the results are 100% practically.
How effective is PEP treatment?
PEP treatment prevents a person who gets exposed to possible HIV infection and prevents his/her life from deadly HIV. Following the complete protocols with medication, the results are always HIV negative when you go for HIV testing after the completion of PEP therapy (after 28-30 days course).
Is PEP safe?
Yes, PEP is safe for both men and women but some persons may get minimal side effects that subside at their own in two to three days. It is the 100% effective at preventing HIV.
Does PEP treatment have any side effects?
Drugs/ medicines in PEP treatment are safe but in some people may cause side effects like nausea, diarrhea, and headache for two to three days and then the body adapts the changes to fight the HIV infection. These side effects can be treated if persist for more than two to three days and are not life threatening.
What is post PEP TESTING?
Post PEP treatment testing after one month (4 weeks) will detect 95% of infections. Testing after three months will detect 99.9% of infections. These tests are considered confirmation tests of being NEGATIVE after PEP treatment started within 72 hours of possible exposure.
What are the guidelines of PEP treatment?
Guidelines include- PUBLIC HEALTH APPROACH: This approach seeks to ensure the possible access to high quality services for a balance between best proven standard of care and feasibility.
PROMOTE HUMAN RIGHTS: A balance between protecting population health and protection of human rights.
What is the PEP regimen?
PEP is a system of medicines which consists of minimum four drugs. It contains level 1, level 2, level 3 drugs eg; if a patient had sexual intercourse with a person who is suffering from HIV and he/she is having drug resistance then the normal drugs for PEP will not work. In such cases we have to use those drugs which can treat the patient and prevents from becoming HIV positive.
What are the PEP therapy instructions?
PEP (post exposure prophylaxis) is a therapy that includes taking antiretroviral medication after the possible/ potential exposure to HIV within 72 hours of possible exposure to prevent from becoming infected by consulting an HIV specialist. It is an emergency treatment that is started within 72 hours only. After 72 hours, this treatment is not indicated. In such cases the protocols are different.
Does PEP therapy works if started after 72 hours of HIV exposure?
No, PEP therapy has little or no effect in preventing HIV infection if started after 72 hours of possible exposure. PEP therapy is started within 72 hours of possible exposure only and not after 72 hours.
What is the PEP dosage?
PEP dosages are different for children below 10 years of age, adults, and older people. An age appropriate regimen is prescribed and that is not same for every individual.
Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your body's ability to fight the organisms that cause disease.
HIV is a sexually transmitted infection (STI). It can also be spread by contact with infected blood or from mother to child during pregnancy, childbirth or breast-feeding. Without medication, it may take years before HIV weakens your immune system to the point that you have AIDS.
There's no cure for HIV/AIDS, but there are medications that can dramatically slow the progression of the disease. These drugs have reduced AIDS deaths in many developed nations.
The symptoms of HIV and AIDS vary, depending on the phase of infection.
Primary infection (Acute HIV)
Most people infected by HIV develop a flu-like illness within a month or two after the virus enters the body. This illness, known as primary or acute HIV infection, may last for a few weeks. Possible signs and symptoms include:
Muscle aches and joint pain
Sore throat and painful mouth sores
Swollen lymph glands, mainly on the neck
These symptoms can be so mild that you might not even notice them. However, the amount of virus in your bloodstream (viral load) is quite high at this time. As a result, the infection spreads more easily during primary infection than during the next stage.
Clinical latent infection (Chronic HIV)
In some people, persistent swelling of lymph nodes occurs during this stage. Otherwise, there are no specific signs and symptoms. HIV remains in the body and in infected white blood cells.
This stage of HIV infection generally lasts around 10 years if you're not receiving antiretroviral therapy. But sometimes, even with this treatment, it lasts for decades. Some people develop more severe disease much sooner.
Symptomatic HIV infection
As the virus continues to multiply and destroy your immune cells — the cells in your body that help fight off germs — you may develop mild infections or chronic signs and symptoms such as:
Swollen lymph nodes — often one of the first signs of HIV infection
Oral yeast infection (thrush)
Shingles (herpes zoster)
Progression to AIDS
Thanks to better antiviral treatments, most people with HIV in the U.S. today don't develop AIDS. Untreated, HIV typically turns into AIDS in about 10 years.
When AIDS occurs, your immune system has been severely damaged. You'll be more likely to develop opportunistic infections or opportunistic cancers — diseases that wouldn't usually trouble a person with a healthy immune system.
The signs and symptoms of some of these infections may include:
Soaking night sweats
Persistent white spots or unusual lesions on your tongue or in your mouth
Persistent, unexplained fatigue
Skin rashes or bumps
When to see a doctor
If you think you may have been infected with HIV or are at risk of contracting the virus, see a health care provider as soon as possible.
Problems like prostate cancer and UTI are very common in male. They require special attention and need to be treated by urologist. There are many best urologist in Delhi. Urologist are specialises in treatment of common diseases related to the male reproductive system. Here is a list of best urologists in Delhi you can get in touch with.
DNB (Urology), MS, MBBS
Dr. Shalabh Agrawal in 17 years of his career is associated with some reputed hospitals like Artemis & Metro hospital. He is known for his knowledge and efficiency as a urologist, urological surgeon and andrologist. He has handled many types of cases in his career and is particularly interested in endo-urology and laparoscopy. He also deals with treatment like cyst in kidney, hematuria, erectile dysfunction, HIV, and kidney transplant. He is currently associated with - One Health Urology Clinic, Gurgaon & Arcus Superspeciality Center- Delhi.
Consultation fees: ₹600
MBBS, MS - General Surgery, DNB - General Surgery, MCh - Urology, MNAMS - Urology
Dr. Sudhir Khanna is a famous urologist. He currently practices at Sir Ganga Ram Hospital and is the chairman of deptt of Urology. He is a member of Delhi Medical Council. In 29 years of his practice, he has also performed various surgeries including cancer surgeries and kidney transplant. He is also known for his successful treatment of erectile dysfunction, infertility.
Consultation fees: ₹1500- 2000
Fellowship of the Royal College of Surgeons (FRCS), MS, MBBS
Dr. Kuldip Singh has 45 years of experience and is a popular Urologist in Delhi. He is affiliated with National Heart institute and The Maples Medical Centre, Delhi. He is an expert in treating prostate, kidney and bladder tumors with robotic surgeries, neo bladder for bladder cancers and Penile prosthesis surgery for erection problem.
Consultation fees: ₹1000
DNB (Urology), MS - General Surgery, MBBS
Dr. Aditya Pradhan has 28 years of experience and is a reputed urologist in his profession. He He specializes in Cystoscopy, hematuria, treatment of erectile dysfunction, H.I.V treatment, hydrocele treatment, Incontinence treatment, kidney transplant treatment, lithotripsy procedure, treatment of male sexual problems and Men’s health. He is currently associated with multiple hospitals and clinics like BLK Super speciality hospital.
Consultation fees: ₹600-1100
MBBS, MS - General Surgery, DNB (Urology)
Withmore than 16 years of experience, Dr. Nikhil Sharma is a well known name in the field of urology. He is currently practicing at Shanti Mukand Hospital Earch Centre and ClearMedi Hospital. He is known to treat all kind of urology problems, including prostate and bladder cancer as well as erectile dysfunction.
Consultation fees: ₹600
DNB (Urology), MS (Gen Surgen), MBBS
Dr. Tanuj has 12 years of experience and is associated with Sarvodaya hospital and SCI Hospital. He has successfully conducted many scarless laser surgeries for removal kidney stones. He also specializes at prostate surgeries like RIRS (retrograde intrarenal surgery) and HOLEP (holmium laser enucleation of prostate).
Consultation fees: ₹450- 800
7. Dr. Saurabh
Dr. Saurabh has more than 15 years of experience and is a leading urologist in Delhi. He has treated several cases in all kind of urologIical diseases in his career. His areas of special interest are stone, prostate, genitor-urinary strictures, various urological cancers, erection and infertility problems. He was part of the team which did India’s first robotic urology surgery. He currently is associated with Moolchand Hospital and Dr. Saurabh’s clinic- Delhi.
Consultation fees: ₹800
MBBS, MS - General Surgery, MCh - Urology
Dr. Anirudh Kaushik is an experienced Urologist and Andrologist with 25 years of experience. He is currently practicing at Holy Care Family Hospital. He holds a special interest and expertise in treating prostate related problems, stone surgeries and male infertility. He has conducted several open and endoscopic urological operations and surgery for malignancy and transurethral surgeries.
Consultation fees: ₹1000- 1200
MBBS, MS - General Surgery, MCh - Urology, FAMS
Dr Narmada Prasad Gupta is a reputed urologist in Delhi - NCR with 47 years of practice. He is a member of some of the famous and prestigious organisations like Indian Medical Association (IMA), Association of Surgeons of India (ASI), Indian Association Of Cosmetic Laser Surgeon (ACLS), Indian Society of Organ Transplantation (ISOT) and Urological Society of India (USI). in his career he has successfully treated cases suffering from prostate cancer, enlargement, testicular cancer and other problems related to urology as well as cases of sexual dysfunction in male. He is currently practicing at Medenta.
Consultation fees: ₹1200
MBBS, MS - General Surgery, DNB - Urology/Genito - Urinary Surgery
Dr. Durrani has close to 10 years of experience and is currently running his own clinic- DURRANI UROSURGERY HOME CLINIC and also visits as a consultant at Fortis Hospital He is known for his holistic approach and a compassionate care, in his treatment. Some of the areas in which he specializes are conducting transurethral resection of the prostate also called as TURP, lithotripsy and cystoscopy. He is good at diagnosis and treating different problems related to the female and male urinary tract and male reproductive system
Consultation fees: ₹600-1000
What is PEP?
PEP stands for post-exposure prophylaxis. It means taking antiretroviral medicines (ART) after being potentially exposed to HIV to prevent becoming infected.
PEP must be started within 72 hours after a recent possible exposure to HIV, but the sooner you start PEP, the better. Every hour counts. If you’re prescribed PEP, you’ll need to take it once or twice daily for 28 days. PEP is effective in preventing HIV when administered correctly, but not 100%.
Learn more about how to protect yourself and get information tailored to meet your needs from CDC’s HIV Risk Reduction Tool (BETA).
Is PEP right for me?
If you’re HIV-negative or don’t know your HIV status, and in the last 72 hours you
think you may have been exposed to HIV during sex (for example, if the condom broke),shared needles and works to prepare drugs (for example, cotton, cookers, water), or were sexually assaulted,talk to your health care provider or an emergency room doctor about PEP right away.
PEP should be used only in emergency situations and must be started within 72 hours after a recent possible exposure to HIV. It is not a substitute for regular use of other proven HIV prevention methods, such as pre-exposure prophylaxis (PrEP), which means taking HIV medicines daily to lower your chance of getting infected; using condoms the right way every time you have sex; and using only your own new, sterile needles and works every time you inject.
PEP is effective, but not 100%, so you should continue to use condoms with sex partners and safe injection practices while taking PEP. These strategies can protect you from being exposed to HIV again and reduce the chances of transmitting HIV to others if you do become infected while you’re on PEP.
What is HIV?
HIV stands for Human Immunodeficiency Virus. It’s a virus that’s passed from person to person through the blood stream. Once HIV is in the blood stream, it begins to attack a person’s immune system and works to kill off healthy immune system cells.
There’s currently no cure for HIV; once a person is diagnosed with the virus it stays in their system for life. There are, however, many quality medications available to help people who live with HIV.
How does HIV work?
HIV belongs to a group of viruses called Retroviruses which work by invading the genetic material of cells within your body. Normally, the body’s immune system would fight off such a virus, but HIV stops this from happening by infecting CD4, or T-cells, which are the cells that fight off infection. The virus can live in the body for years without causing obvious damage, though it will continue replicating over this time.
What happens if you are infected with HIV?
A person infected with HIV is described as "HIV positive", meaning that they receive a "positive" result from a blood test for HIV infection.Many people with HIV continue to look and feel well throughout their lifetime. They may not even be aware that they are living with the virus. However, many HIV positive people do eventually develop different infections and cancers that the body would otherwise normally be able to fight. This can lead to an HIV positive person being diagnosed with AIDS.
Hearing that a person is HIV positive instantly makes us wary of him or her and unconsciously we may begin avoiding social interactions with them. However, HIV does not spread through the air or by water and hence there is no reason to ostracize HIV positive people. To understand how to prevent the transmission of HIV it is essential to first understand how the virus is transferred from one person to another. There are three ways in which this virus can be transmitted from an HIV positive person to another. These are:
Keeping this in mind, here are a few ways to prevent the transferring of HIV from one person to another:
HIV cannot be cured but it can be controlled through medication. Hence, if you suffer from this disease, follow the doctor's prescription religiously to prevent transmitting the virus to your partner.
Human immunodeficiency virus (HIV) has been conclusively known to be the causative agent for AIDS (Acquired Immune Deficiency Syndrome) which is a major killer disease of the modern times affecting almost 50 million people around the world.
The virus that causes ‘ Aids’ – HIV belongs to a family of viruses known as retroviruses. HIV looks like a rolled up porcupine. It contains two snakes like single strands of RNA along with reverse transcripts firmly wrapped up in a core, giving HIV its characteristic appearance.
On entering the white blood cells known as CD 4 cells, HIV produces its own DNA and sees to it that this gets inserted into the DNA of the host cell. The viral DNA has enough power and information to direct the destiny of the cell. It can force the cell to manufacture several new copies of HIV. However due to certain trigger and regulatory mechanisms, the viral DNA lies dormant in the host cell for several years before it begins to do the damage.
It has been known that CD4 lymphocytes are mainly affected by the HIV when these classes of lymphocytes are destroyed. It produces an immunological imbalance in the body and weakens the resistance to several opportunistic infections, consequently leading to death. The medicines available at present produce a decrease of the viral load, but as they are immunosuppresents they can produce a deterioration of the patients’ immunity.
People infected with HIV may take 7 – 10 years to develop AIDS.
AID/HIV in Ayurveda may be considered as Ojakshaya, meaning the loss of Vital Energy or immunity. The symptoms, Signs and Causative factors (Nidan), and the Treatment aspect has been described in many Ayurvedic Treaties like Charak Samhita, Susrutha Samhita and Ashtanga Hrudaya, Bhavprakash, Vaidya Chintamani and Chakradatta etc.
Ojas is essence of our body. Ojas is otherwise explained as ‘Bala’ (strength or immunity) and ‘Dhatusara’. Ojas is of two types namely, ‘para ojas’ and ‘Apara ojas’. The ‘ojas’ of para(excellent) type is eight drops in quantity, is located within the heart and death occurs when this get depleted. The other type ‘Apara ojas’ is also known as ‘sleshmaka ojas’, the quantity of which is described as Ardha Anjali and distributed throughout the body. When this ojas is not affected the bodily functions will be normal.
In conditions like HIV/AIDS, where loss of ojas is a prominent feature, people are found to be susceptible to various other diseases or infections.
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.