Post-exposure prophylaxis for HIV infection in Singapore

Post-exposure prophylaxis or post-exposure prevention (PEP) of HIV infection is any preventive medical treatment started immediately after exposure to the virus in order to prevent infection and the development of disease.

PEP is a course of antiretroviral drugs which reduces the risk of seroconversion after events with high risk of exposure to HIV (e.g., unprotected anal or vaginal sex, needlestick injuries, or sharing needles). The CDC recommends PEP for any HIV-negative person who has recently been exposed to HIV for any reason.

To be most effective, treatment should begin within an hour of exposure. After 72 hours post-exposure PEP is much less effective, and may not be effective at all. Prophylactic treatment for HIV typically lasts four weeks.

While there is compelling data to suggest that PEP after HIV exposure is effective, there have been cases where it has failed. Failure has often been attributed to the delay in receiving treatment (greater than 72 hours post-exposure), the level of exposure, duration of treatment (lack of adherence to the 28 day regimen), or all three. However, given that—for non-occupational exposures—the time and level of exposure are based on patient-supplied information, absolute data is unavailable. The standard antibody window period begins after the last day of PEP treatment. Doctors will advise patients who received PEP to get an antibody test at 6 months post-exposure as well as the standard 3 month test.

The antiretroviral regimen used in PEP is the same as the standard highly active antiretroviral therapy used to treat AIDS. It requires close compliance and can have unpleasant side effects including malaise, fatigue, diarrhea, headache, nausea and vomiting.

A report from early 2013 revealed that a female baby born with the HIV virus displayed no sign of the virus two years after high doses of three antiretroviral drugs were administered within 30 hours of her birth. The findings of the case were presented at the 2013 Conference on Retroviruses and Opportunistic Infections in Atlanta, U.S. and the baby is from Mississippi, U.S. The baby—known as the "Mississippi baby"—was considered to be the first child to be "functionally cured" of HIV. However, HIV re-emerged in the child as of July 2014.

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This article was written by Roy Tan.