POST EXPOSURE PROPHYLAXIS (PEP)

Sejojo Phaaroe

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

THE TRANSMISSION OF

HIV How do you become infected with HIV?

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

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:

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

HIV can only be transmitted through:

Unprotected sexual intercourse

Infected blood

Intra-venous drugging

Mother-to-child

X

Unprotected sexual intercourse

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

Where are OIs come from in the health work place ?

• Food

– Raw vegetables, fruits

– Raw meat, eggs, poultry

– Stored food, unwashed food

• Water

– Cryptsporidiosis, microsporidiosis

• Air

– TB, Cryptocococcus

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

Indicators for PEP

• Occupational exposure – cut,

• Non occupational exposure -bite -Sexual assault - crime scene attendants - car accident • Condom breakage

PEP SERVICE PACKAGE

• behavioural change counselling • STI testing and treatment • Pregnancy testing and prevention

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

FOLLOW UP TESTS

-HIV HBSG 6 WEEKS , 3 MONTHS, 6 MONTHS

REGIMEN

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

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

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

Thank you