What is post-exposure prophylaxis (PEP)?
PEP refers to the short-term antiretroviral treatment (ART) to reduce the likelihood of
HIV infection after potential exposure to the virus, either occupationally or through
sexual intercourse. In the health sector, PEP should be provided as part of a
comprehensive precaution package that reduces the hazards of exposure to
infection at work.
How does ART work?
- The HI virus enters the body and attaches itself to the cells that build immunity.
- The virus then starts to multiply, killing the protective cells.
- This process may take several hours to days.
- ART stops the virus from multiplying.
- The sooner PEP is started the better the chances of reducing viral multiplication and helping the body to eliminate the virus.
- ART must be given as soon as possible, preferably within one to two hours, but can be given up to 72 hours after exposure.
Prophylaxis after sexual assault
- Rape is a common crime in South Africa.
- Many rape cases are not reported because of the fear of being judged by the community or being ill-treated by officials.
- There is not enough data to demonstrate the effectiveness of PEP after sexual intercourse, but because of the effectiveness of PEP after occupational exposure, it is now being used in all cases of exposure.
- All adults and children over 14 must be counselled and the following points covered:
- HIV status of victims
- Risk of transmission of HIV
- Tests to be carried out immediately or within 72 hours (3 days)
- Patients are given a three-day starter pack. If the HIV test results are negative the patient completes the four-week course.
- PEP must not be given to those who test HIV positive.
- Patients start therapy on two drugs, AZT and 3TC, for 28 days to prevent HIV transmission.
- A third drug, Lopinavir/Ritonavir, is added in high-risk cases.
High-risk, post-sexual exposure
- Multiple perpetrators
- Anal penetration
- Trauma to the genitals
- If one of the perpetrators is known to be HIV positive
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