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Introduction
Antiretroviral therapy (ART) offered as PEP has become the standard of care for healthcare workers who have had occupational exposure to HIV. Although there is no data to show
that ART is effective at preventing transmission from non-occupational exposures (e.g. sexual), the principles of management are similar.
HIV Exposure Risk
The table below shows the risk of HIV transmission following various exposures. These are only estimates, and in reality, the odds of infection with a specific exposure are hard
to estimate as the risk of HIV transmission is affected by many factors such as the viral load of the infected person, presence of other sexually transmitted diseases etc.
Certain sexual practices (receptive anal intercourse) carry much higher risk than others (insertive oral sex).
Generally, exposures to saliva, urine, tears and sweat are not thought to be infectious.
Exposure Estimated Risks
Needle stick injury 1/300
Receptive anal intercourse 1/100
Receptive vaginal intercourse 1/1000
Insertive vaginal intercourse 1/2000
Insertive anal intercourse 1/2500
Receptive fellatio with ejaculation 1/2500
Sharing needles 1/150
Criteria for NOPEP against HIV
The following criteria should be used:
* There is high risk exposure (any unprotected anal or vaginal intercourse, receptive fellatio with ejaculation) with: (1) a partner known to be HIV-infected, or (2) in HIV-risk
group (men who have sex with men, bisexual men, IV drug users, commercial sex workers), or (3) patient was raped.
* Patient must make a commitment to safe sex.
* Patient must make an informed decision regarding potential risks and benefits of the treatment offered.
* Exposure must have taken place within the last 72 hours, as initiating PEP after 72 hours is not advised.
Regimen
Singapore HIV PEP offers a triple drug combination of Combivir® (zidovudine 300mg/lamivudine 150mg) 1 tablet twice a day AND Kaletra® (lopinavir 200mg/ritonavir 50mg) 2 tablets
twice a day both for a total of 28 days.
Side Effects
The drugs used can all cause GIT side effects i.e. nausea, diarrhoea, anorexia
ZDV: most side effects are dose-related; major side effect is haematological - anemia, granulocytopenia; pigmentation of nails reported
3TC: well-tolerated; rash, hair loss, vasculitis, photophobia, paraesthesia
Kaletra: diarrhea, nausea, headache, asthenia, rash, insomnia
Counselling
It is important to inform & discuss that:
* There is no absolute proof that ART PEP decreases risk of HIV, although there is supportive evidence based on biologic plausibility, animal studies and in a single study on
HCW.
* The treatment is not 100% effective, as there have been documented cases of seroconversion after occupational exposures despite PEP.
* Side effects will be encountered with medication.
* Most importantly, issues of safer sex and how to prevent future exposures must be addressed. |
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Author Resource:-
Here are some Singapore HIV PEP that I found for sale. Welcome to our website to get more infoamation about us.
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By :
Abbot Smith
Submitted
2010-06-28 01:59:55 |
Article From Article Mayhem
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