First Aid: The first 72 hours After…

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Post-exposure prophylaxis (PEP) for HIV infection

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Post Exposure Prophylaxis (PEP) broadly refers to a short term course of medications started immediately after an exposure to a source of disease causing organism in order to prevent developing the disease. PEP is widely used in many infectious diseases such as Hepatitis B and C, Rabies following a dog bite, Tetanus toxoid after a dirty wound, and now HIV.

PEP for HIV infections applies the same principle by taking antiretroviral medications to reduce the likelihood of developing HIV infection after a potential occupational, accidental or sexual exposure to HIV. Healthcare workers are highly at risk of contracting it from accidental needle stick injuries or from blood or body fluid splashes into their eyes or mouth- although theoretically, the chances of HIV transmission via the routes is said to be about 1%, prevention is certainly better than cure! PEP for sexual exposure comes in very handy in scenarios like a condom breakage or sexual assault.

Once a person is exposed to the body fluids of a known infected person, that individual is absolutely advised to seek PEP within 72 hours of the incident.

HIV Post-Exposure Prophylaxis Protocol- First AidIt is crucial to know the HIV status of the source.  Therefore if the status of the source is not known it is highly recommended to have them available for testing to ascertain their viral load and level of infectivity.

Before the drugs are commenced, the exposed individual is screened to ensure that there is no previous infection already present. In most protocols, PEP course consists of 2-3 antiviral drugs and the medications may be taken for up to 28 days. The length of time may vary as the doctor deems fit based on the degree of exposure. It is not unusual to experience difficulty in drug compliance especially because the drugs may have some unpleasant side effects.

For those who have accidental contact through a sharp object, allow the blood to flow, run water over the cut area until it is clean then, cover the injured surface with clean gauze and go to a medical centre for treatment and PEP.

POST EXPOSURE PROPHYLAXIS IS NOT 100% EFFECTIVE. PEP does not guarantee that a HIV exposed person will not get infected with the virus, however it reduces the chances that someone exposed to a potential source of infection will end up infected.  For PEP to be effective it must be started 48-72 hours after the time of exposure, before the virus has the time to rapidly replicate within the blood stream.

Ultimately, the best way to live risk free is to prevent exposure to all sources of infection. For sexual contacts, follow the ABC rule of Abstinence, Be Faithful to 1 partner, and use a Condom.

Summary Protocol for HIV Post-Exposure Prophylaxis (PEP)

  1. Allow the blood to flow
  2. Run water over the cut area until it is clean
  3. Cover with a clean gauze and visit a medical centre for PEP
  4. Individual is screened for HIV (to rule out any prior infection)
  5. Where possible, test the source to determine level of infectivity
  6. Commence on prophylactic medications
  7. Upon completion, re-run lab test to confirm status and do another HIV-antibody testing by at least 6 months post-exposure. Counsel individual to practice safe sex during this interval.

 

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