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If you believe
that you need PEP, the following section
explains what you should do. It will be helpful
to bring this information with you to the
clinic.
[ link to
PDF document of this section
which can be downloaded/printed ]
Act immediately. The sooner you start PEP, the
more likely it is to be effective. If you put
yourself at risk at the weekend, do not wait
until Monday to act.
Try to contact your local sexual health clinic
first. Ask to speak to a sexual health nurse or
health adviser urgently. If this isn't possible,
you should explain that you think you've been
exposed to HIV and want to talk to someone about
being given PEP. Ask for the names of whoever
you speak to and write them down – this could
speed things up when you go to the clinic later.
If you cannot find a clinic that is open (most
aren't open at weekends) you can go to an
Accident & Emergency (A&E) department of a local
hospital. If the A&E department is part of a
hospital with its own HIV ward or clinic, it
should be easier to get PEP there as staff from
that clinic will be knowledgeable about PEP and
the medication will be available.
What to do at a clinic or A&E department
Speaking to a doctor
Taking an HIV test
What drugs will they use?
Taking PEP
What to do at a clinic or A&E department
Go to the reception and explain you want to see
someone urgently about PEP (post-exposure
prophylaxis) to prevent HIV infection. If you
have already spoken to someone on the phone,
give their name. If you haven't, tell reception
staff that you think you've been exposed to HIV
and you want to speak to a nurse or health
adviser about being given PEP.
Tell them you need to see someone as soon as
possible, and be determined. Don't agree to come
back later. You must start PEP within 72 hours
of putting yourself at risk of HIV, but the
sooner you start the treatment the more likely
it is to be effective.
If you are at the A&E department of your local
hospital it may help to ask them to call the
'on-duty HIV registrar' who will have experience
in PEP and HIV.
Speaking to a doctor
When you get to speak to a doctor or nurse, tell
them you want PEP and give details of when and
how you were at risk of HIV infection.
PEP has only been used for sexual exposure to
HIV since guidelines were issued in 2004. If the
doctor you are speaking to is unfamiliar with
PEP, refer him or her to the British Association
for Sexual Health and HIV (BASHH) guidelines for
post-exposure prophylaxis after sexual exposure
(PEPSE) to HIV. These guidelines can be accessed
at:
http://www.bashh.org/documents/58/58.pdf.
There will be a number of questions to answer so
that the doctor can decide if you need PEP. It
is important to provide honest answers. You will
be asked about the following:
-
When you think you were at risk.
-
The sex you had (e.g. was it oral or anal
sex; was semen involved; was a condom used).
-
The person you had unsafe sex with (to try
and determine if they had HIV or not).
These questions are asked to try to establish
what your risk of infection is. This will depend
on the likelihood of your partner being
HIV-positive and how risky the sex you had was.
If you know that your partner was HIV-positive
it may be easier for you to get PEP, especially
if he is willing to go to the clinic or hospital
with you.
Taking an HIV test
PEP will not be given to someone who is already
HIV-positive and so they will need to give you
an HIV test to check you don't already have HIV.
PEP won't be offered if someone refuses to be
tested. You must also agree to be tested after
you have finished the course of PEP to see if
it's worked.
What drugs will they use?
The drugs used for PEP are a triple combination
of anti-HIV drugs. 3, These are commonly
selected from:
Either
AZT (also called zidovudine) and 3TC (lamivudine)
– also available in a combination pill called
Combivir,
Or
Tenofovir and FTC (emtricitabine) – also
available in a combination pill called Truvada
Plus one of the following:
lopinavir or fosamprenavir or saquinavir
However, other drugs may be used for PEP. These
drugs should be taken together for one month.
Taking PEP
The drugs used for PEP are expensive and
powerful so the decision to offer treatment is
not taken lightly.
PEP uses the same drugs that treat HIV infection
so you are likely to experience the same kind of
side effects as people who are beginning to take
HIV medication. Common side effects include
diarrhoea, nausea, headaches, and tiredness. In
rare cases more serious side effects, such as
liver damage, can occur. The doctor will need to
explain the effects of these medications before
you start PEP.
Some people often stop taking PEP or miss doses
due to these side effects, but this stops the
treatment from working. In order to have the
greatest chance of success, every dose of PEP
must be taken as prescribed. If you find you
have missed a dose, take it as soon as you
remember it. Do not just wait and take a double
dose at the time you are next due – this can be
dangerous.
Reference:
BASHH Guideline. UK Guideline for the use of
post-exposure prophylaxis for HIV following
sexual exposure. International Journal of STD &
AIDS 2006; 17: 81–92
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