PEP: In Case of Emergency

Published: September 10, 2013

 When HIV-negative people are exposed to the virus—say, through a condom break, a safer-sex “slip up” or a sexual assault—they can prevent an infection from taking hold if they start a daily regimen of meds called post-exposure prophylaxis, or PEP. 

 This summer, when a New York man went to a hospital emergency room and requested PEP, he was initially refused the treatment. After a call to activist group ACT UP, he got the meds—and PEP got in national headlines.
 PEP is an important prevention tool, not only for those who are negative, but also for HIV-positive people in serodiscordant relationships (i.e., their partners are negative). “We want to make sure we can do everything we can to protect our partners,” says Reed Vreeland, communications coordinator for the Sero Project and an active member of ACT UP New York. “If a condom breaks, we want to make sure we can send our partners somewhere they’ll get effective treatment immediately that will greatly reduce their chances of becoming HIV positive.”
So what’s the hold-up with PEP? How accessible is it, where is it, and how can you be proactive about acquiring it? 
PEP is a course of treatment that can prevent HIV transmission after a person is potentially exposed to the virus via infected blood, genital secretions or bodily fluids.
 Often coined the “HIV morning-after pill,” PEP must be started within 72 hours after a person is put at risk. But unlike the one-time Plan B contraception pill, PEP requires taking at least three antiretroviral (ARV) medications daily (sometimes a few times a day) for 28 days. They are the same drugs HIV-positive people take daily to keep the virus from replicating once it has a foothold in the body.
“It takes about five days for HIV to work itself through our bodies and into our bloodstream,” writes Antonio Urbina, MD, of the Spencer Cox Center for Health and the executive producer of “Once HIV enters into the bloodstream, a person is infected with HIV and nothing can be done to reverse this infection. PEP works by blocking HIV’s ability to make copies of itself. By doing this, the HIV virus is contained and destroyed by the body before it has a chance to cause infection.”
PEP is not to be confused with pre-exposure prophylaxis, or PrEP, which is when HIV-negative people take a daily course of Truvada (a combo pill of two HIV meds) to lower their risk of infection in case of a future exposure. For more on PrEP, click here.
 In 1996, PEP studies showed a 79 percent reduction in the odds of seroconversion for health care workers who experienced a potential occupational exposure, such as a needlestick injury. Since then, oPEP—for occupational exposures—has been standard of care for health care workers. 
 Activists began demanding PEP for non-occupational exposure—nPEP—for example, if you had unprotected sex. In 2005, the Centers for Disease Control and Prevention (CDC) updated its PEP guidelines, making it standard of care for everyone. The New York State Health Department followed suit in 2008. 

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