Hiv post exposure prophylaxis on your medical elective
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HIV post exposure prophylaxis on your medical elective. Dr Sarah Barrett Consultant GUM/HIV Birmingham Heartlands Hospital. PEP. PEP. Post Exposure Prophylaxis (PEP) is a course of antiretrovirals that can stop you becoming HIV positive after you've been exposed to the virus. Introduction.

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Hiv post exposure prophylaxis on your medical elective l.jpg

HIV post exposure prophylaxis on your medical elective

Dr Sarah Barrett

Consultant GUM/HIV

Birmingham Heartlands Hospital



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PEP

Post Exposure Prophylaxis (PEP) is a course of antiretrovirals that can stop you becoming HIV positive after you've been exposed to the virus.


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Introduction

  • What is high risk?

    • Countries

    • Injuries

  • What do I do if I get a needlestick?

  • What do I need to know about the drugs?

    • Timing

    • Side effects

    • Interactions

    • Cost!

  • How do I get the drugs

    • PEP clinic

    • Reselling of drugs

  • Questions


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Increased risk overseas...

‘Of the 14 ‘possible’ occupationally acquired HIV infections reported in the UK, 13 had worked in areas of high HIV prevalence and were probably infected abroad’


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Increased risk overseas...

‘Of the 14 ‘possible’ occupationally acquired HIV infections reported in the UK, 13 had worked in areas of high HIV prevalence and were probably infected abroad’

why?


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Increased risk overseas...

‘Of the 14 ‘possible’ occupationally acquired HIV infections reported in the UK, 13 had worked in areas of high HIV prevalence and were probably infected abroad’

why?

  • Higher prevalence of HIV infection

  • lack of standard infection control measures

  • poor or inadequate equipment leading to increased risk of exposure

  • Relative inexperience/lack of technical skills of students

  • No Post exposure prophylaxis







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What is high risk?

  • Risk of acquiring HIV from occupational exposure is LOW

    • Needle stick 3 in 1000

    • Mucocutaneous 1 in 1000

    • Intact skin, urine, vomit, saliva, faeces – negligible


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What is high risk?

  • Risk of acquiring HIV from occupational exposure is LOW

    • Needle stick 3 in 1000

    • Mucocutaneous 1 in 1000

    • Intact skin, urine, vomit, saliva, faeces – negligible

    • Receptive vaginal intercourse 1 in 500

    • Receptive anal intercourse 1 in 30


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What is high risk?

  • Increased risk if

    • Deep injury

    • Visible blood

    • Injury with a needle which had been placed in a source patient’s artery or vein.

    • Terminal HIV-related illness in the source patient.



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Prevention

  • Wear gloves

  • Do NOT put yourself in risky situations

  • Goggles

  • Safe disposal of needles

  • Wear a condom (!)



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Following any exposure

  • Wash liberally with soap and water, don’t scrub!

  • Antiseptics and skin washes should not be used

  • Encouraged gentle bleeding of puncture wounds

  • Irrigate exposed mucous membranes copiously with water

  • Report injury to Dr in charge

    • They need to assess the source patient


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PEP

  • Viral dissemination does not occur immediately

  • leaves a window of opportunity during which PEP may be beneficial

  • Most efficacious if started within the hour

  • Definitely within 72hours

  • If in doubt, take it and stop after further information obtained



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The drugs

  • Two Kaletra tablets (protease inhibitor) bd

  • One Truvada tablet (Tenofovir and FTC) od

  • No food restrictions

  • PEP pack can be stored at room temperature

  • Starter pack contains 4 days

  • Should continue for 28 days (enough given to source more locally or come home)

  • Benefits should outweigh risks of drugs


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Problems with the drugs...

  • Side effects

    • Commonly gastrointestinal (e.g. Nausea and diarrhoea) beware dehydration

    • Dizziness and headache.

    • Skin rash

  • Interactions

    • www.hiv-druginteractions.org


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The good news is....

  • Antiretroviral medication has become more widely available in high HIV prevalence countries

  • Prior to departure make enquiries whether PEP protocols are established in your elective centre

  • If PEP is not available consider taking a PEP starter pack


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The Pre-elective PEP clinic

  • You will receive an email containing details about 2 months before departure

  • Risk assessed

  • Baseline HIV test (+ ?confidential STI screen)

  • Written information given

  • Pack with gloves/needles and condoms

  • Prescription for 4 days of drugs if appropriate

  • £96 (cost of drugs only)


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Reselling of drugs...

  • NOT encouraged!

  • Trust the person you are buying from

  • Ensure drugs are in date

  • Ensure attend PEP clinic

    • Baseline HIV test

    • Instructions

    • Medical kit


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Questions....?

[email protected]


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