Dr.Deyn Natthakhet Yaemim (Founding Director) 6 June 2016, last updated 24 August 2022

PEP (Emergency PEP)

Key Points

• PEP treatment involves taking anti-HIV drugs for 28 days after possible exposure to HIV.
• Before prescribing PEP, doctors will assess your risk of HIV infection.
• PEP is available at sexual health clinics as well as accident & emergency departments.
• We recommend the ned medication called KOCITAF.

HIV PEP has to be taken within the first 72 hours after exposure. If you have a high risk, you should start PEP immediately.

The sooner PEP is taken the more effective it is. Taking PEP within the first 24 hours PEP has been proven by years of studies to be able to reduce the chance of HIV transmission.

If you are at high risk due to any of these factors, you may need to seek PEP:

• You have an HIV-positive partner who is not on treatment.
• You had anal/vaginal penetrative sex without a condom
• Condom broke or leaked during the intercourse
• Bleeding
• Having cuts or ulcers
• You’re uncircumcised
• You were exposed to potentially HIV-infected body fluids
• You were exposed to HIV less than 72 hours ago.
• You have a sex partner with a high risk (for example, men who have sex with men or they are from Africa or SEA).
• You have had sex with penetration not knowing of their status.

If more than 72 hours have passed, even if it has been almost a week since the exposure, do seek a doctor for consultation and treatment. Primarily, the healthcare provider may assign 3-drug antiviral combinations if you become HIV-positive. You could minimize the damage the virus may cause to your immune system.

What is the mechanism of Emergency PEP?

After exposure, HIV takes 2-3 days to settle in the human body. You’ll always be HIV-positive if you get infected. If PEP is taken in time, it can help prevent the virus from growing, it will die out before spreading further. PEP helps the immune system so the infected cells won’t replicate the virus and die naturally not so long after.

Is Emergency PEP 100% Effective?

PEP cannot cure HIV but it can prevent the virus from establishing in the body if taken in time. Most people who took PEP within the right time span after exposure to HIV don’t get infected.

Is it too late if you’re already exposed to HIV?

It can be stopped if you act fast. HIV needs a little time before it spreads and stays forever in the body. If the patient gets to PEP fast enough (in 72 hours), there's a high chance the body can get rid of the virus successfully.

I won’t become HIV-positive if I take PEP?

Research has proven that PEP drastically reduces the chance of being infected with HIV. However, PEP isn’t 100%. Some people become HIV-positive even after taking PEP. The reasons for the cases that lead to PEP not working could be:

• It’s been too long after the exposure
• the patient skips doses. PEP needs to be taken every day for 28 days.
• A rare case of the patient developing anti-HIV drug resistance resulting in some strains of HIV not being able to be treated with certain PEP*
• HIV has already developed too far in the body for PEP to stop the virus**
• Having more exposure to HIV while taking PEP

WHAT WOULD BE DONE WHEN RECEIVING EMERGENCY PEP AT PULSE CLINIC?

1. Consultation

2. Rapid screening for HIV, Hepatitis B virus with results in 15 minutes, accuracy 99.9%

3. Kidney function tests

4. PEP Medications

5. Test or treatment for possible sexually transmitted infections

WHAT HIV PEP DRUGS DO WE USE?

We offer the most advanced PEP medicines with few side effects and effective HIV prevention to be taken for 28 days.

For adults, Tenofovir paired with either Tenofovir (TDF) or emtricitabine (FTC) is the preferred combination to treat HIV.

The 3rd drug will be assigned by the doctor. It’ll be another HIV medicine recommended by WHO and CDC.

If you happen to acquire the type of HIV that causes resistance, traditional HIV drugs won’t work. Therefore, some doctors recommend using advanced medicines because they can be effective against resistant strains. Those high-class medicines are available at our clinic and are more expensive than regular PEP. The doctor will prescribe the premium PEP if your risk is high based on your evaluation.

Are there other tasks that should be done?

Patients might as well receive treatment for possible gonorrhoea, chlamydia, or syphilis. At PULSE Clinic, we offer PCR28, a test that can detect 28 infections in one go.

YOU DON'T NEED PEP IF...

- Your partner has got tested and is HIV-negative

- Your partner has HIV but was treated and has the status ‘undetectable viral load'

- You get bitten

- Semen of others gets in your eyes

WHAT ARE SOME POSSIBLE QUESTIONS?

The healthcare provider will evaluate the risk of your potential exposure to HIV before initiating the treatment.

You will be asked about the events that make you believe you’ve been exposed to HIV. They will ask for details like the types of sexual activity or the partner’s medical history. The doctor will ask if they are HIV-positive and about their status like undetectable viral load. You will be asked about specific details of the sexual event of that potential exposure, for example, anal, vaginal, or oral, the roles (e.g., who penetrated whom), whether ejaculation occurred inside either party and any other concerns you may have.

It is very important to be honest and provide accurate information – WE are there to help you, not to judge you.

Your answer will be used to evaluate if the situation is urgent.

The risk of contracting HIV through oral sex is very low. Post-exposure prophylaxis (PEP) is not recommended if the potential HIV exposure is through oral sex, unless the patient has engaged in receptive oral sex with a partner confirmed to have HIV, and the patient has cuts, lesions, or ulcers in their mouth.

We understand that it can be hard to come forward for the first time but you can really trust PULSE Clinic. We’ve seen more than 4000 cases, it’s such a normal thing. The doctor will never judge and will be nothing but helpful. If you’re at risk, contact us for PEP.

WHAT ARE THE SIDE EFFECTS OF PEP?

New PEP rarely has side effects. Side effects occur in less than 1% of our patients who use new PEP.

Common side effects (in less than 1% of cases) are nausea, diarrhea, and fatigue.

Rash and fever are uncommon, happening in less than 0.1% of the patients.

Australian research on the side effects among patients who use raltegravir and emtricitabine/tenofovir disoproxil as PEP. The most frequently reported side effects included fatigue (37% of PEP users), diarrhea (25%), nausea (24%), flatulence (24%), abdominal cramps (21%), bloating (16%), headache (15%), vivid dreams (15%), depression (10%), and thirst (10%).

PEP causes fewer side effects than before. When there are fewer side effects, patients find it easier to complete the 28-day regimen

HOW DO I REMIND MYSELF TO TAKE PEP EVERY DAY?

Below are some suggestions that might help you remember to take PEP daily throughout the month:

• Set a daily alarm to take your medications.
• Take PEP at the same time each day
• Put your PEP near something you use daily
• Take PEP at the same time you brush your teeth and place the medications near your toothbrush so you can see them easily.
• Place a post-it note with the letter 'P' on your refrigerator reminding you to take your medication.
• If you plan to be away from home, make sure to take enough PEP with you.
• Find a friend you can trust this with to help remind you.

IS IT OK TO TAKE OTHER DRUGS WHILE YOU ARE ON PEP?

PEP could interact with various medications, including other prescribed drugs, supplements, and vitamins. Other drugs can potentially affect the efficacy of PEP. Engaging in recreational drug use during PEP treatment can pose risks, as the interaction can cause severe side effects. It is important to discuss any prescription or recreational drugs you are taking with the healthcare provider.

I HAVE COMPLETED MY 28-DAY COURSE OF PEP, WHAT DO I DO NEXT?

After completing the 28-day course of PEP, it's important to schedule a follow-up with your healthcare provider or return to our facility for an HIV test. Our doctor will evaluate your risk factors and may suggest the use of PrEP for continued HIV prevention. It is recommended that the patient undergo another HIV test three months after to make sure that the treatment works. Regular testing and consultations with your healthcare provider are crucial steps in maintaining your health and ongoing protection against HIV.

WEEKEND EMERGENCY PEP IN BANGKOK, PHUKET, KUALA LUMPUR, SINGAPORE, HONG KONG

PULSE CLINIC opens 7 days a week, so you can get to us as soon as possible once you’re potentially exposed to HIV even over the weekend. You can schedule an appointment or simply walk in at any of our branches.

Estimated HIV transmission risk per exposure for specific activities

Sources: vaginal sex;1 anal sex;2 fellatio;3 2 mother-to-child;4 other activities.5

References

1. Boily MC et al. Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies. Lancet Infect Dis 9(2): 118-129, 2009

2. Vittinghoff E et al. Per-contact risk of human immunodeficiency virus transmission between male sexual partners. American Journal of Epidemiology 150: 306-311, 1999

3. Del Romero J et al. Evaluating the risk of HIV transmission through unprotected orogenital sex. AIDS 16(9): 1296-1297, 2002

4. Townsend C et al. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000-2006. AIDS 22: 973-981, 2008

5. Baggaley RF et al. Risk of HIV-1 transmission for parenteral exposure and blood transfusion. AIDS 20: 805-812, 2006