Helpful information on getting PEP

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What to do at a clinic or A&E department

Go to the reception and explain you want to see someone urgently about PEP (Post Exposure Prophylaxis) to prevent HIV infection. If you have already spoken to someone on the phone, give their names. If you haven’t, tell reception staff that you think you’ve been exposed to HIV and you want to speak to a nurse or health adviser about being given PEP.

Tell them you need to see someone as soon as possible and be determined. Don’t agree to come back later; while you must start PEP within 72 hours of putting yourself at risk of HIV, the sooner you start PEP the more likely it is to be effective.

If you are at the A&E department of your local hospital it may help to ask them to call the ‘on-duty HIV registrar’ who will have experience in PEP and HIV.

Speaking to a doctor

When you get to speak to a doctor or nurse, tell them you want PEP and give details of when and how you were at risk of HIV infection.

PEP has only been used for sexual exposure to HIV since guidelines were issued in 2004. If the doctor you are speaking to is unfamiliar with PEP, refer him or her to the British Association for Sexual Health and HIV (BASHH) guidelines for post-exposure prophylaxis after sexual exposure (PEPSE) to HIV. These guidelines can be accessed at: http://www.bashh.org/documents/58/58.pdf

There will be a number of questions to answer so that the doctor can decide if you need PEP. It is important to provide honest answers. You will be asked about the following:

When you think you were at risk.
The sex you had (e.g. was it oral or anal sex; was semen involved, was a condom used).
The person you had unsafe sex with (to try and determine if they had HIV or not).

These questions are asked to try to establish what your risk of infection is. This will depend on the likelihood of your partner being HIV positive and how risky the sex you had was. If you know that your partner was HIV positive it may be easier for you to get PEP, especially if he is willing to go to the clinic or hospital with you.

HIV test

PEP will not be given to someone who is already HIV positive and so they will need to give you an HIV test to check you don’t already have HIV. PEP won’t be offered if someone refuses to be tested. You must also agree to be tested after you have finished the course of PEP to see if it’s worked.

What drugs will they use?

The drugs used for PEP are a triple combination of anti-HIV drugs. These are commonly selected from:

Either

AZT (also called zidovudine) and 3TC (lamivudine) – also available in a combination pill called Combivir,

Tenofovir and FTC (embtricitabine) – also available in a combination pill called Truvada

Plus one of the following:

lopinavir or fosamprenavir or saquinavir

However, other drugs may be used for PEP. These drugs should be taken together for one month.

Taking PEP

The drugs used for PEP are expensive and powerful so the decision to offer treatment is not taken lightly.

PEP uses the same drugs that treat HIV infection so you are likely to experience the same kind of side effects as people who are beginning to take HIV medication. Common side effects include diarrhoea, nausea, headaches, and tiredness. In rare cases more serious side effects, such as liver damage, can occur. The doctor will need to explain the effects of these medications before you start PEP.

Some people often stop taking PEP or miss doses due to these side effects but this stops the treatment from working. In order to have the greatest chance of success, every dose of PEP must be taken as prescribed. If you find you have missed a dose, take it as soon as you remember it. Do not just wait and take a double dose at the time you are next due – this can be dangerous.