Written by Dr.Deyn Natthakhet Yaemim (Founding Director) on 6 June 2016, last updated 28 Fevruary 2021

If you have had a high risk exposure to HIV in the last 72 hours, PEP must be started within 72 hours after a possible exposure to HIV.
It is most effective when started within 24 hours, the sooner someone starts PEP the better prevention.

Factors that can increase the risk of HIV infection and you are a potential candidate for PEP due to:

• The partner is known to be HIV positive AND is not on treatment.
• Anal sex with penetration without condom
• Vaginal sex without condom
• Condom break
• Presence of blood
• Presence of cuts or ulcers
• You are not circumcised
• You have been exposed to potentially HIV infected body fluids
• Your exposure was less then 72 hours ago
• Partner of unknown HIV status who belong to higher risk HIV group (e.g. MSM or from africa or S.E.Asia)
• They penetrated you (Their penis, your arse) AND you don't know for sure whether they have HIV or not.

However, if you are unable to access PEP within the 72 hours, even if it has been up to 5-7 days since the exposure occurred, it is still worth seeking medical advice to see what your options are. This may include commencing a 3-drug combination of antiretroviral medications as soon as possible just in case you have become HIV positive. In this case, you would be starting very early treatment and minimising the damage to your immune system.

WHAT IS PEP?

PEP means Post-Exposure Prophylaxis. It refers to a management to prevent HIV infection for those who are HIV negative and potentially exposed to HIV, by taking PEP it means the person is taking AntiRetroviral medication to prevent/stop HIV from being established in the body of the person.

HOW DOES PEP WORK?

It takes a few days for HIV to become established in the body following exposure. Once it is established you will have HIV for the rest of your life. However, if you begin taking PEP in time, the anti-HIV drugs will prevent the HIV (that's already in your body) from reproducing and it DIES out before it has a chance to multiply. PEP drugs given at this time may help the body’s immune system to stop the virus from replicating (multiplying) in the infected cells of the body. The cells originally infected would then die naturally within a short period of time without producing more copies of HIV.

HOW WELL DOES PEP WORK?

The golden period for PEP medication is 72 hours after a potential exposure to HIV, and it is proven to be highly effective if it is started within this period. PEP can make sure that you won’t be infected with HIV, regardless of the means that you caught it. However, you must take it daily for at least 28 days, and on top of daily dosage, it must be at the same hour every day. This is because the PEP drug will show its full effectiveness if taken as mentioned.

IS PEP FOR ME?

PEP is the right tool for you to use to prevent yourself from getting HIV if  

• you’re HIV-negative or don’t know your HIV status
• you may have been exposed to HIV during sex (for example, if the condom broke) within the last 72 hours 
• you shared needles with someone else within the last 72 hours
• you were sexually assaulted

BUT IF THE HIV VIRUS IS ALREADY IN THE BODY, ISN’T IT TOO LATE?

Not if you act quickly. After HIV gets in the bloodstream it takes some time before it permanently establishes itself in the body. If a person who has been exposed to HIV acts quickly to get PEP (within 72 hours) they stand a good chance of stopping the virus from establishing itself in their body.

SO, IF I TAKE PEP I WON’T BECOME HIV POSITIVE?

Research indicates that taking PEP makes infection with HIV a lot less likely. But PEP doesn’t work every time – some people who take it still end up with HIV afterwards. It can fail because:

- the person doesn’t or isn’t able to take PEP as prescribed (every day for a month)

- some anti-HIV drugs don’t work against some strains of HIV (HIV drug resistant, although this is rare)*

- the initial viral load (the amount of HIV) in the body was too great for the drugs to be effective**

However, the sooner PEP treatment is begun after exposure to the virus, the more likely it is to work.

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

1. Consultation

2. Rapid screening for HIV, Hepatitis B virus with result 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 use the latest gold standard PEP medicines with fewer side effects and better HIV prevention which will be taken for 28 days.

For adults: Tenofovir combined with either Tenofovir (TDF) and emtricitabine (FTC) as preferred backbone drugs and these are also the preferred drugs for treating HIV.

The recommended third drug, which is also recommended by WHO and CDC as a preferred drug for HIV treatment, will be chosen by your doctor.

There are some of our clients who do not understand when our doctors try to explain about HIV drug resistant. If you are unlucky and being exposed to such HIV, the classic PEP medications are not able to help you. That's why American CDC suggested on their PEP treatment guidelines that we should use a higher class of drugs that is less likely to be resisted by the HIV drug resistant type. These higher class medications are available at our clinics and they are costly. Much more expensive than the classic PEP medications generally used in low income countries. When our doctors prescribe this higher class PEP medications it is because they evaluate that your risk is very high and they are trying to keep the standard as high as American Center of Disease Control Guidelines for PEP treatment.

WHAT ELSE SHOULD BE DONE?

At PULSE CLINICs, your doctor might advice that you get treatment as prevention for possible gonorrhoea, chlamydia, syphilis after unprotected sex or sexual accident. And they will suggest that you get tested to sreen for STIs/STDs such as ureaplasma parvum, ureaplasma urealyticum, mycoplasma hominis, mycoplasma genitalium, trichomonas vaginalis, LGV because up to 70% of people who are infected do not have any symptoms (asymptomatic infecitons) and pass on the infections to other people without knowing. Most of us think that STDs/STIs are transmitted through sexually contact only but in 2021 that's not true anymore because we know that there are numbers of STDs/STIs that spread via direct contact (skin-to-skin) such as touching.

YOU DON'T NEED PEP IF...

- You are confident that your partner doesn't have HIV.

- The partner is HIV positive and on successful treatment (Known as ‘undetectable viral load')

- Human bites

- Another person's semen gets in your eye.

WHAT WILL DOCTOR ASK ME?

The doctor will try to evaluate how likely it is you have actually been exposed to HIV before starting treatment.

Questions will include what happened to make you think you’ve been exposed to HIV, what sort of sexual or injecting activity or partner is likely to be HIV-positive. We will ask you things like if you know whether the person has HIV (and if they are HIV-positive, if you know if they have an undetectable viral load), and in the case of a possible exposure through a sexual encounter, we will ask about things like: the kind of sex you had (e.g., anal, vaginal or oral sex); if you fucked them or they fucked you; if either of you came inside the other; and if there is anything else you are worried about.

"It is important to be honest and accurate in providing this information – WE are there to help you, not to judge you."

and the information will help us to assess the seriousness of the situation.

The risk of getting HIV from oral sex is extremely low. PEP is not recommended after possible exposure to HIV through oral sex. The only exception would be following receptive oral sex from a partner known to have HIV and when the receptive partner has cuts or lesions such as ulcers in their mouth.

At PULSE CLINICS (every branches throughout Asia) we have seen this more than 5000 times before, you're not the first and not the last. The doctor won't judge, He/She will be very helpful and make you feel at ease. If you think you're at risk and need PEP, call us.

WHAT ARE THE HIV PEP SIDE EFFECTS?

With the new PEP drugs we use, side effects are very rare. Fewer than 1 in 100 of our patients actually develop any side effects.

Common side effects (<1%) include nausea, diarrhoea and feeling tired. Rash and fever are uncommon (< 0.1%) side effects. So does PEP have any side effects? Some side effects like nausea, dizziness, may occurred but they usually subside in one week. These side effects aren’t life-threatening.

HOW TO TAKE PEP CORRECTLY?

- PEP must be started within 72 hours after a recent possible exposure to HIV, but taking it as soon as possible is the best way to do.

- 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%

HOW LONG DO I NEED TO TAKE PEP?

The PEP guidelines around the world stated that PEP should be taken 28 days to achieve a successful treatment. However, most drugs will contain 30 pills in a bottle, which leads to some healthcare provider to sell the whole 30 pills in a bottle instead of separate pills. Anyway, all you need is 28 days of treatment and then you're done. You don't need to take it for 30 days. 
There have been small animal studies that have suggested 28 days is optimal and a case-control study of health care workers showed failure of PEP when the 28 days of treatment was not completed. Therefore, current guidelines recommend that 4 weeks of PEP should be used.

HOW CAN I REMEMBER TO TAKE MY PEP?

Here are a few tips that may help you remember to take PEP each day for the month:

- Set a daily alarm or reminder on your mobile phone to remind you to take your medications.

- Take your drugs at the same time each day (e.g., after breakfast, after dinner).

- Put your PEP drugs near something you use daily, as a reminder.

- Take your medications at the same time you brush your teeth – and place the medications near your toothbrush so you will notice them.

- Keep a post-it-note attached to your fridge or noticeboard with the letter ‘P’ on it; this will be a discreet reminder to you to take your drugs.

- If you are planning a big night out, carry enough of your PEP drugs to take in case you don’t make it home.

- Get someone you trust to remind you to take your medications.

HOW CAN I PAY FOR PEP

You can check the PEP cost at your nearby healthcare provider as each place will have different pricing for this service. You can enquire about the payment options too, as some places will accept only in cash but not cards.
PULSE CLINICS accept payment with credit cards, debit card, cash and bank transfer.
Check with your insurance company if PEP is covered, we can issue a medical certificate together with receipt, many of our patients use that to be reimbursed form their insurance.

CAN I DRINK ALCOHOL WITH PEP?

You may drink moderate amounts of alcohol (within normal recommended safe limits) while taking this medication.

TAKING OTHER DRUGS WHILE YOU ARE ON PEP

PEP can interact with other drugs (including other prescription drugs, supplements and vitamins) and change the way the PEP drugs work. Taking recreational drugs while on PEP can be risky. Recreational drugs can have severe side-effects in combination with some of the PEP drugs. Talk to the doctor or nurse who prescribes you PEP about any other prescription or recreational drugs you may be taking or planning to take. If you wish to take recreational drugs while on PEP, talk to the doctor who prescribed you PEP. If you usually take multivitamins, calcium tablets or treatment for indigestion, please discuss this with the Doctor or Nurse as they may affect how well the Raltegravir is absorbed.

CAN I STOP TAKING MY PEP AFTER STARTED IT AND NOT FINISH THE COURSE OF 28 DAYS?

Once started, it is not recommended to stop even though you will get HIV PCR test and it may comes out negative. Stopping the PEP course before 28 days is highly dangerous as it may result in PEP failure, and failing treatment means a risk of getting HIV infection.

WHY DOES PEP FAIL?

There’re possibilities that PEP can fail to prevent HIV infection. This is due to four possible reasons,

1. The period before taking PEP isn’t truly within 72 hours. There may be another risk before that and the patient was not aware of or did not tell the doctor before start taking PEP. 
2. Some people bought PEP from internet without getting tested for HIV to confirm they are HIV negative, so when they took the PEP it doesnt really help them but on the other hand it might makes it worse because if he's already HIV positive (without knowing) and take the PEP which could act as treatment for HIV and when he stops he might develop drug resistant HIV mutation in his body and he can spread it to other people. Scary!
3. The patient was exposed to someone with very high viral load such as a person with acute HIV infection and the amount of HIV in the load was too high and PEP could not work to prevent him even though he may take PEP within 72 hours after exposure.
4. The patient didn’t take PEP for at least 28 days as prescribed. Some people really don't want to continue to take it for 28 days. They might take it for a week and get HIV PCR RNA test, and when the result come back negative he stops taking PEP. Or the patient might take PEP for 2 weeks then get HIV Combo test and when he tested negative he sotps taking PEP thinking it's OK.
5. The patient continues to have more risks or exposure to HIV even when he/she's on PEP.
6. Some anti-HIV drugs don't work against some strains of HIV (although this is rare) that's why it is important to take the latest PEP that have more mechanisms to prevent HIV form being established in the body after exposure.

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

Once you've finished the course of PEP, see your provider or come back to us to get tested for HIV, the doctor will evaluate your risks and might recommend you to start taking PrEP. You should get tested again 1 and 3 months after you have finished the PEP to confirm your HIV status this is because PEP can delay HIV infection!

CAN I TAKE PEP EVERYTIME I HAVE BAREBACK SEX?

Well, practically yeah sure you can take PEP every time you have unprotected sex but it is not recommended because preventing the infection after the risks has happened is not better than preventing it BEFORE the risk will happen. There's a thing called PrEP which refers to Pre-Exposure Prophylaxis which means you take PrEP and you are protected even before you have sex. If you can anticipate any unprotected sex in the future you better take PrEP in-advance to protect yourself as it is cheaper than a course of PEP (and less terrifying), and PrEP can prevent you from HIV infection up to 99% if you take it daily. Want to know more about PrEP? Read here

Where Can I Get PEP? 

Weekend emergency PEP is possible in Bangkok, Phuket, Kuala Lumpur, Singapore, Hong Kong.
PULSE CLINICS open 7 days a week, so you will be safe by us even though you have an exposure or sexual accident on the weekend. Just book an appointment with us or simply walk in at all our branches.

 Thailand
PULSE Clinic Silom Bangkok info.silom@pulse-clinic.com
PULSE Clinic Nana Bangkok info.nana@pulse-clinic.com  
PULSE Clinic Patong Beach, Phuket info.phuket@pulse-clinic.com 
PULSE Clinic Sukhumvit 37, Bangkok (Open March 2021)
PULSE Clinic Airport Link Phayathai, Bangkok (Open April 2021)
EU Clinic – Executive Health Asoke, Bangkok (Coming soon)
EU Clinic – Executive Health Ploenchit, Bangkok (Coming soon)

 Malaysia
PULSE Clinic Bukit Bintang, Kuala Lumpur info.kl@pulse-clinic.com  +601165388678
PULSE Clinic Bangsar, Kuala Lumpur info.kl@pulse-clinic.com +601165388678

 Hong Kong
PULSE Clinic Central, Hong Kong info.hk@pulse-clinic.com

 Singapore
PULSE Clinic Tanjong Pagar, Singapore info.sg@pulse-clinic.com  +6589451492

PULSE CLINIC PrEP Online Department 
ForCountries Without PULSE CLINICS and EU Clinic, contact #BuyPrEPonline 

#BuyPrEPonline #iwantprepnow #PrEPatPULSE #PulseClinicBKK #PrEPinBangkok #prepinKL #prepinMalaysia #prepinPhuket #prepinHongKong #prepasian

Estimated HIV transmission risk per exposure for specific activities and events

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

6. Binta Sultan et al. Current perspectives in HIV post-exposure prophylaxis. HIV AIDS (Auckl). 2014; 6: 147–158.

7. Tsai CC, Emau P, Follis KE, et al. Effectiveness of postinoculation (R)-9-(2-phosphonylmethoxypropyl) adenine treatment for prevention of persistent simian immunodeficiency virus SIVmne infection depends critically on timing of initiation and duration of treatment. J Virol. 1998;72(5):4265–4273.

8. Cardo DM, Culver DH, Ciesielski CA, et al. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. Centers for Disease Control and Prevention Needlestick Surveillance Group. N Engl J Med. 1997;337(21):1485–1490.

updated on 28 February 2021.