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A Brief of HIV Post Exposure Prophylaxis following Sexual Violence

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A presentation on pep kie

  1. 1. A PRESENTATION ON POST EXPOSURE PPROPHYLAXIS PURITY KAJUJU LIVERPOOL VCT, CARE & TREARTMENT 27 TH APRIL 2010
  2. 2. POST EXPOSURE PROPHYLAXIS (PEP) <ul><li>Administration of a combination of Anti-Retroviral drugs (ARV’s) for 28 days following exposure to HIV. </li></ul><ul><li>PEP is recommended for men, women, girls and boys at risk of HIV infection. </li></ul><ul><li>The 2004 National ARV guidelines suggest offering 2 ARV’s for PEP. </li></ul><ul><li>The WHO/ILO PEP guidelines also recommend duo therapy (WHO, 2007). </li></ul><ul><li>Administered by a trained health practitioner </li></ul>
  3. 3. SOURCES OF EXPOSURE <ul><li>1 . Body fluids containing HIV – </li></ul><ul><li>High Risk: Blood, pus, breast milk </li></ul><ul><li>Low risk – saliva, </li></ul><ul><li>2. Sexual intercourse - semen, vaginal secretions </li></ul><ul><li>3. Needle prick injuries </li></ul>
  4. 4. RISK OF EXPOSURE <ul><li>dependent upon: </li></ul><ul><li>health care personnel practices </li></ul><ul><li>the prevalence of the illness </li></ul><ul><li>the amount and frequency of exposure </li></ul>
  5. 5. WHEN TO PRESCRIBE PEP <ul><li>High risk exposure + known source status, HIV positive </li></ul><ul><li>High risk exposure + Known source HIV negative + Risk factors </li></ul><ul><li>High risk exposure + Unknown source status </li></ul>
  6. 6. WHEN SHOULD YOU NOT OFFER PEP? <ul><li>After exposure through any route with low </li></ul><ul><li>risk materials (e.g. urine, vomit, saliva, </li></ul><ul><li>faeces) unless they are visibly bloodstained </li></ul><ul><li>Where testing has shown that the source is HIV negative, or if risk assessment has </li></ul><ul><li>concluded that HIV infection of the source </li></ul><ul><li>is highly unlikely </li></ul>
  7. 7. TIMING OF PEP FOR HIV <ul><li>The efficacy of PEP decreases with the length of time from exposure to the first dose. </li></ul><ul><li>Administering the first dose is a priority. </li></ul><ul><li>Effective up to 80% if given within 72hrs , but ASAP after the exposure. </li></ul><ul><li>72 hours after assault, PEP is not effective, but offer all other aspects of post rape care. </li></ul>
  8. 8. COMMON SIDE EFFECTS ARE <ul><li>nausea </li></ul><ul><li>headaches </li></ul><ul><li>tiredness </li></ul><ul><li>general aches and pains </li></ul><ul><li>-Reduce SE by taking pills with food. </li></ul><ul><li>-These SE improve with time. </li></ul><ul><li>-Short course do not cause any long-term damage. </li></ul><ul><li>-Lab clinical monitoring important. </li></ul>
  9. 9. MONITORING FOR PEP Baseline, within 3 days of starting PEP <ul><li>Blood </li></ul><ul><li>HIV </li></ul><ul><li>- HIV negative, continue PEP. </li></ul><ul><li>HIV positive, discontinue PEP, refer to care. </li></ul><ul><li>Hemoglobin level. </li></ul><ul><li>ALT/Creatinine – Liver functions </li></ul><ul><li>Urine </li></ul><ul><ul><li>PDT – Pregnancy test </li></ul></ul><ul><ul><li>Microscopy </li></ul></ul><ul><li>(DNA Analysis) </li></ul><ul><ul><li>Hair </li></ul></ul><ul><ul><li>Nail clippings/scrapings </li></ul></ul><ul><ul><li>Body Fluid </li></ul></ul>
  10. 10. PEP FOR SEXUAL ASSAULT SURVIVORS
  11. 11. ASSESSMENT TO DETERMINE WHETHER PEP IS INDICATED <ul><li>Assess and carefully weigh the </li></ul><ul><li>following factors: </li></ul><ul><li>whether or not a significant exposure has </li></ul><ul><li>occurred during the assault </li></ul><ul><li>knowledge of the HIV status of the alleged </li></ul><ul><li>assailant </li></ul><ul><li>whether the survivor is ready and willing to </li></ul><ul><li>complete the PEP regimen </li></ul>
  12. 12. DEGREE OF RISK BASED ON TYPE OF EXPOSURE <ul><li>significant exposure </li></ul><ul><li>Provide PEP </li></ul><ul><li>Where direct contact of the vagina, anus, or mouth with </li></ul><ul><li>the semen or blood of the alleged assailant, with or </li></ul><ul><li>without physical injury, tissue damage, or presence of </li></ul><ul><li>blood at the site of the assault. </li></ul><ul><li>Or where broken skin or when mucous membranes of </li></ul><ul><li>the survivor have been in contact with blood or semen </li></ul><ul><li>of the alleged assailant. </li></ul><ul><li>In cases of bites that result in visible blood. </li></ul>
  13. 13. CONSIDERING THE HIV STATUS OF THE ALLEGED ASSAILANT <ul><li>Unless the identity and HIV status of the alleged </li></ul><ul><li>assailant has been clearly established to assist with the </li></ul><ul><li>decision-making: </li></ul><ul><li>PEP should be promptly initiated when a significant risk </li></ul><ul><li>exposure has occurred. </li></ul><ul><li>Even when the alleged assailant is known to be HIV </li></ul><ul><li>infected, the decision to recommend PEP should be based on the nature of the exposure and the survivor’s ability to complete the regimen. </li></ul><ul><li>If prophylaxis has been initiated and the alleged assailant </li></ul><ul><li>is found to be HIV antibody negative, then PEP should be </li></ul><ul><li>discontinued. </li></ul>
  14. 14. FOLLOW-UP HIV TESTING <ul><li>HIV Antibody testing for 6 months post-exposure at 6 weeks, 3 months, 6 months </li></ul><ul><li>Viral Load testing not recommended unless HIV Infection suspected </li></ul>
  15. 15. POST-EXPOSURE PROPHYLAXIS: CORE PRINCIPLES <ul><li>Evidence is limited </li></ul><ul><li>Balancing of risks vs. benefits </li></ul><ul><li>Timing: the sooner the better, but interval beyond which there is no benefit is unclear </li></ul><ul><li>Optimal duration unclear, 28 days is recommended </li></ul><ul><li>Decision making can get very complex when resistance in PEP suspected </li></ul>
  16. 16. POST-EXPOSURE PROPHYLAXIS: CORE PRINCIPLES <ul><li>SEX PEP SHOULD BE CONSIDERED FOR RISKY EXPOSURES AND DOES NOT APPEAR TO INCREASE UNSAFE SEXUAL BEHAVIOR FOR MOST RECIPIENTS. </li></ul>
  17. 17. <ul><li>Questions???? </li></ul><ul><li>Thank you wonderful people!! </li></ul>

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