Tag Archives: Post Exposure Prophylaxis

We really can beat HIV!

In October 2017, Public Health England reported an 18% drop in the numbers of people diagnosed with HIV in 2016 – this includes 18% fewer diagnoses among people of black African ethnicity compared to 2015.

This was the first time that we’ve had such a significant drop and it is was all down to a combination of things we can all do to make a difference.

New ways to stop the spread of HIV

The HIV epidemic started more than 30 years ago but recently there have been some big changes which we want to share with you and make sure everyone knows about. The number of HIV infections is starting to come down in some areas and this is down to a combined approach to stopping HIV. It’s no longer JUST about condoms, HIV treatment is now a part of our armoury against HIV – and part of protected sex.

Here’s how:

1) Treatment as Prevention (TasP)

If someone is on effective HIV treatment and has an ‘undetectable viral load’ they cannot pass on HIV. (The viral load is the amount of HIV measured in a blood test – most clinics in the UK classify undetectable as being below 20 copies/ml.)

We are saying this based on findings from the PARTNER study which looked at 888 gay and straight couples (and 58,000 sex acts) where one partner was HIV positive and on effective treatment and one was HIV negative. Results found that where the HIV positive partner had an undetectable viral load, there were no cases of HIV transmission whether they had anal or vaginal sex without a condom. It can take up to six months from starting treatment to become undetectable.

What this means: This is exciting news as it means treatment is a new way to stop the spread of HIV. Don’t forget though that sex without a condom still means you can get or pass on another sexually transmitted infection (STI) and can result in a pregnancy.

2) Pre-exposure prophylaxis (PrEP)

PrEP is a course of HIV drugs taken by an HIV negative person who is at risk of getting HIV to lower their chance of becoming infected. When taken correctly, PrEP significantly reduces the chances of becoming HIV positive.

In England PrEP is not currently available on the NHS routinely, although 10,000 people will be taking it as part of the IMPACT trial, which started this autumn. In Scotland and Wales PrEP is available on the NHS.

What this means: If you are likely to be exposed to HIV, PrEP is another way to protect yourself.

3) Post-exposure prophylaxis (PEP)

PEP is a month-long course of HIV medication taken by an HIV negative person after possible exposure to reduce the chance of getting HIV. When started in time (within 72 hours, but within 24 hours is best) PEP can stop HIV infection after sex without a condom (or other exposure) with someone who is infectious – but it does not work every time.

What this means: PEP is the third way HIV treatment can be used to protect yourself, a doctor will assess whether you will be eligible or not depending on the risk taken.

Testing and treatment saves lives

In terms of stopping HIV this new information is monumental and the facts show that people power can dramatically reduce HIV transmissions. Regular testing means more people with HIV will be diagnosed and taking treatment – so they will be less likely to become ill and less likely to pass on HIV.

Despite the good news of a drop in HIV rates, 54% of newly diagnosed black African people were diagnosed late in 2016, which means they will have an increased risk of developing an AIDS-defining illness. The British HIV Association (BHIVA) recommends everyone with HIV starts treatment when they are diagnosed. This is because a study called START found that starting straight away significantly reduced people’s chances of developing AIDS-related illnesses.

So the problem we have is that although lots of us are being diagnosed and getting onto treatment in time, an even bigger proportion are finding out they have HIV at a point where their immune systems have been damaged. Regular testing is the linchpin of reducing late diagnoses and keeping people well.

Additionally, people are extremely infectious when they are first infected with HIV which is why early diagnosis is so important – if you are on effective treatment and have an undetectable viral load you cannot pass on HIV.

The Simple Science

HIV stands for Human Immunodeficiency Virus. It was identified in the early 1980s and belongs to a group of viruses called retroviruses.

HIV uses your CD4 cells to reproduce, destroying them in the process. These are important cells which co-ordinate your immune system to fight off illnesses and infections. As the number declines, you may not have enough to keep your immune system working properly. At the same time the amount of HIV in your body (the ‘viral load’) will usually increase.

Without treatment your immune system will not be able to work properly and protect you from ‘opportunistic infections’.

Effective treatment will mean your CD4 count increases and your viral load decreases – hopefully to ‘undetectable’ levels.

The viral load test shows how much HIV is in your body by measuring how many particles of HIV are in a blood sample. The results are given as the number of ‘copies’ of HIV per millilitre of blood – for example 200 copies/ml.

An ‘undetectable’ viral load does not mean there is no HIV present – HIV is still there but in levels too low for the laboratory test to pick up. Different laboratories may have different cut off points when classifying an undetectable viral load, however most clinics in the UK classify undetectable as being below 20 copies/ml.

Modern HIV treatment means that many people with HIV are living long, healthy lives and if you’re taking HIV medication and have an undetectable viral load you cannot pass on HIV.

Getting tested

Our Rapid HIV testing service is available Monday-Friday between 9am – 4pm.  You do not need an appointment.

The test is performed at our office on Regent Road, Leicester by qualified and experienced HIV testers.  The process usually takes around 20 minutes.

The test is free to ‘at risk groups’ and always confidential.  If you’re not at risk, we can refer you to an alternative service who will be able to provide you with a free HIV test.  You can still test with us for £20 or you may prefer a free Home Sampling kit or buy a Home Testing kit from BioSure for £29.95.  You can also find details of other testing services by clicking here.

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PEP stands for Post Exposure Prophylaxis and is a treatment that may prevent HIV infection after the virus has entered the body.

Post = After
Exposure = A situation where HIV has a chance to get into someone’s bloodstream, like unsafe sex.
Prophylaxis = A treatment to stop an infection happening.

PEP Treatment: 

  • Involves taking anti-HIV drugs for four weeks
  • Must be started as soon as possible after unsafe sex or a condom not working, straight after exposure or within 24 hours is best and no later than 72 hours (three days)
  • Has side effects
  • Is likely to stop HIV but isn’t guaranteed to work

Where do I get PEP?

  • Sexual Health clinics (GUM clinics) – at Leicester Royal Infirmary or the one in your city / town
  • Hospital Accident & Emergency department (A&E) – be prepared to ask for PEP as soon as you can after you book in.
  • Not all of these places in every part of the country will have PEP or be able to prescribe it

PEP – Post Exposure Prophylaxis

How soon?

  • It is best to start PEP straight after exposure or within 24 hours and no later than 72 hours (three days later). The longer you wait there is less chance it will work, after 72 hours PEP isn’t usually given as it’s unlikely to work by then.

But if HIV is in my body doesn’t this mean I will now be infected?

  • No. After HIV gets into your bloodstream it takes from a few hours to a few days before it permanently infects you. If you act in that short time you stand a chance of stopping HIV before the infection takes hold.

How does PEP work?

  • Taking anti-HIV drugs every day for four weeks might stop the HIV before it gets a permanent hold in your body. PEP is not a ‘morning after’ pill that’s taken just once, it’s one month of drug treatment.

So if someone takes PEP they won’t become HIV positive?

  • Research shows PEP makes infection with HIV a lot less likely. But PEP doesn’t always work, some people who take it still end up with HIV after treatment. PEP can fail because some anti-HIV drugs don’t work against some strains of HIV. It’s more likely to fail if it’s not taken properly or soon enough.

Are the drugs the same as the ones taken by people with HIV?

  • Yes, you take three drugs which are also used in ‘combination therapy’ taken by HIV positive people.

Is PEP a cure for HIV?

  • There is no cure for HIV. PEP can only stop the HIV infection if it’s taken very soon after it has entered your body and before the infection takes hold. Once the HIV infection becomes permanent then anti-HIV drugs can’t get rid of the virus. This is because it is not in parts of the body the drugs can’t reach. Once HIV permanently infects someone the drugs can usually control the HIV in their body but can never get rid of it completely.

Does PEP have side effects?

  • Yes, it can cause diarrhoea, headaches, nausea and vomiting. Because of the side effects, you may need time off work or study and some people have to stop taking it. Side effects go once you stop taking the drugs. One Australian study showed that among people taking PEP, side effects were mild to moderate for two out of three people and severe for one in four.

What are the chances someone will get PEP?

  • New guidelines have been given to Sexual Health Clinics that help doctors decide if PEP should be given. A doctor will need to ask questions about:
  • Who you had unsafe sex with, to identify the likelihood of you having HIV.
  • What kind of sex you had, when it happened, whether it was oral, vaginal or anal sex and whether either of you came inside the other.
  • Doctors might sometimes give PEP after oral sex, depending on the circumstances.
  • It’s worth thinking about PEP if you or someone you had anal or vaginal sex with didn’t use a condom or something went wrong with the condom and it’s not later than 72 hours (3 days) since it happened.
  • They will also talk to you about having an HIV test. Before you are given PEP you must have a test to check you don’t already have HIV. You must also agree to be tested after taking PEP to see if it’s worked. PEP won’t be offered if you refuse to be tested.

What if I can’t get to a place that has PEP within 72 hours?

  • After 72 hours PEP won’t usually be offered so if it’s not possible to get to a Sexual Health Clinic in time it is advisable to go to a hospital Accident & Emergency department because they never close.

If I take PEP can I become resistant to HIV drugs so they won’t work if I get HIV later?

  • No, it’s HIV, not your body that can become resistant to the drugs. If PEP works it gets rid of the virus – and the virus can’t become resistant because it’s not there anymore. So if you were to become HIV positive later and needed drugs if wouldn’t make any difference that you took PEP in the past.
  • But if PEP doesn’t work and you become HIV positive, there may be problems with the HIV in your body being resistant to some drugs, including ones used in PEP.

If I’m taking PEP does that make me immune to HIV while I’m on it or when I’ve stopped taking it?

  • No. Unsafe sex while taking PEP could let more HIV into your body, making PEP much more likely not to work.
  • If, after taking PEP you have stayed HIV negative and then you have unsafe sex again, you can become infected just like any other HIV negative person.

Now we have PEP does it matter so much if I don’t use condoms?

  • PEP doesn’t change the need for condoms, here’s why:
  • Using a condom is more likely to stop HIV being passed on than PEP is.
  • Condoms don’t make you ill with side effects, which PEP can.
  • You need a condom for as long as the sex lasts – but PEP lasts for four weeks.
  • Condoms are everywhere. PEP can be hard – sometimes impossible – to get.
  • You control getting hold of condoms but doctors decide if you should get PEP and they may say no.

How many times can I have PEP?

  • Doctors decide who gets PEP and they’re unlikely to give these expensive and powerful drugs to the same person time after time. So if you keep having unsafe sex you will usually be offered help with having safer sex rather than being given PEP lots of times.
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