HIV and HIV transmission Indicators for PEP Pre—requisite for PEP -baseline and follow up tests Pre-requisite for PEP Provision PEP package ARV- Treatment and adherence

1. POST EXPOSURE PROPHYLAXIS
(PEP)
Sejojo Phaaroe

2. Objective
• HIV and HIV transmission
• Indicators for PEP
• Pre—requisite for PEP
• -baseline and follow up tests
• Pre-requisite for PEP Provision
• PEP package
• ARV- Treatment and adherence

3. THE TRANSMISSION OF
HIV
How do you become infected with HIV?

4. UNDERSTANDING HIV / AIDS
H :
I :
V :
HUMAN
IMMUNE DEFICIENCY
VIRUS
HIV is therefore a virus that
breaks down the immune
system within human beings
A :
I :
D :
S :
ACQUIRED
IMMUNE
DEFICIENCY
SYNDROME
AIDS is therefore a collection of
many infections in the body as
a result of a weakened immune
system caused by the HIV Virus

5.  Virus does not survive outside the body
 Cannot enter through intact skin
 Quantity of virus
 Enough time
 Point of entry
 Enough Quantity
THREE CONDITIONS FOR TRANSMISSION:
NO TRANSMISSION BECAUSE:

6. You will NOT transmit HIV through:
SOCIAL CONTACT
Shaking hands, swimming, kissing,
hugging, sharing toilet, cutlery
BEING WITH AN HIV+ PERSON
TRAVELLING
FOOD AND EATING
WORK ENVIRONMENT

7. HIV can only be transmitted through:
Unprotected sexual intercourse
Infected blood
Intra-venous drugging
Mother-to-child
X




8. Unprotected sexual intercourse

9. HIV Clinical stages at different CD + counts (1993 CDC)
CD 4+ COUNT INFECTIONS NEOPLASIA/
CANCERS
>500 cells/ ml CANDIDIASIS
CERVICITIES
CIN
Invasive Cancer of
cervix
Idiopathic
Thrombocytopenia
purpura
Hodkins Lymphoma
Non Hogkins
Lymphoma
K.S
200-500 TB ,
Bacterial pneumonia
Herpes Zoster
Oral candidiasis
Oesophagial candidiasis
CIN
Invasive Cancer of
cervix
Idiopathic
Thrombocytopenia
purpura
Hodkins Lymphoma
Non Hogkins
Lymphoma
K.S
50- 200 Extra pulmonary TB
PCP
Cryptococoosis
Toxoplasmosis
Blastomycetes
Septicaemia
Herpes
Wasting-
Anaemia
Peripheral Neuropathy
Non Hodgkins
Lymphoma
Cardiomyopathy
<50 CMV

10. Where are OIs come from in the health wor
place ?
• Food
– Raw vegetables, fruits
– Raw meat, eggs, poultry
– Stored food, unwashed food
• Water
– Cryptsporidiosis, microsporidiosis
• Air
– TB, Cryptocococcus

11. WHY PEP?
• There may be a window of opportunity in the first few hours
of days after exposure in which the highly active drugs may
prevent HIV infection
• Immediately following an exposure to blood or body fluids,
wounds should be washed with soap and water and should
not be squeezed

12. Indicators for PEP
• Occupational exposure – cut,
• Non occupational exposure
-bite
-Sexual assault
- crime scene attendants - car
accident
• Condom breakage

13. PEP SERVICE PACKAGE
• behavioural change counselling
• STI testing and treatment
• Pregnancy testing and prevention

14. PRE-REQUISITE FOR PEP
• Source: HIV TEST- if Available and consent
• Exposed : HIV test
• if test results positive, no PEP- the client
is advised to go to the HIV clinic to start
baseline procedures
• Baseline tests- HIV
• -PREGNANCY
• HBSAG

15. FOLLOW UP TESTS
-HIV
HBSG 6 WEEKS , 3 MONTHS, 6 MONTHS

16. REGIMEN
- 3TC = Lamivudine
-AZT= Zidovudine
Add 3rd medicine for high risk exposure
- Kaletra

17. adherence
• PEP should preferably be stated within 2
hours of the injury and definitely within 72
hours and continue for 28 days
• Clinicians should closely monitor people
receiving PEP to detect ARV- induced
dangerous effects

18. summary
• PEP might stop a person from getting infected with HIV
• It must be started as soon as possible after exposure- and
definitely within 72 hrs ( 3 days)
• Strict adherence is essential
• Anti-HIV medicine are to be taken for 4 weeks
• Side effects are common and can be debilitating
• ----
• PEP is not suitable for individuals with repeated high – risk
behaviour
• Who are not willing to risk reduction practices
• Primary prevention remain maintain in control of HIV not
PEP

19. Thank you