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Introduction
Antiretroviral treatment (ART) offered as PEP has become the standard of attach to healthcare operators who have had occupational exposure to HIV. Although there is no data to show
that ART is effective by preventing transmission from non-occupational exposures (e.g. ######ual),
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HIV Exposure Risk
The table below shows the risk of HIV transmission retinue various exposures. These are merely estimates, and in reality, the odds of infection with a characteristic exposure are hard
to estimate as the risk of HIV displacement is affected along many elements such as the viral load of the infected human,
Mens abercrombie vest, presence of additional ######ually transmitted diseases etc.
Certain ######ual practices (receptive anal intercourse) carry many higher risk than others (insertive oral ######).
Generally, exposures apt saliva,
dr dre headphones, urine, tears and sweat are no thought to be contagious.
Exposure?Estimated Risks
Needle?????? stick?????????????? harm?1/300
Receptive?? anal????? intercourse?1/100
Receptive?? vaginal?? intercourse?1/1000
Insertive???? vaginal?? intercourse?1/2000
Insertive???? anal?????? intercourse?1/2500
Receptive??? fellatio? with? ejaculation?1/2500
Sharing????????????????????? needles?1/150
Criteria for NOPEP opposition HIV
The emulating criteria should be used:
* There is tall risk exposure (any unprotected anal or vaginal intercourse, receptive fellatio with ejaculation) with: (1) a associate known to be HIV-infected, or (2) in HIV-risk
team (men who have ###### with men, bi######ual men, IV drug consumers, commercial ###### workers), or (3) patient was raped.
* Patient must make a commitment to safe ######.
* Patient must make one informed determination regarding latent hazards and benefits of the treatment attempted.
* Exposure must have taken place within the final 72 hours, as initiating PEP after 72 hours is not warned.
Regimen
Singapore HIV PEP offers a treble drug alignment of Combivir? (zidovudine 300mg/lamivudine 150mg) 1 pill twice a day AND Kaletra? (lopinavir 200mg/ritonavir 50mg) 2 tablets
twice a day either for a absolute of 28 days.
Side Effects
The pills accustom can entire cause GIT side effects i.e. nausea, diarrhoea, anorexia
ZDV: maximum side effects are dose-related; major side achieve namely haematological – anemia, granulocytopenia; pigmentation of nails reported
3TC: well-tolerated; rash, cilia wastage, vasculitis, photophobia, paraesthesia
Kaletra: diarrhea, nausea,
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Counselling
It is major to advise & argue that:
* There is no utter proof that ART PEP decreases risk of HIV, nevertheless there is supportive certify based above biologic plausibility, animal studies and in a unattached learn on
HCW.
* The treatment is not 100% effective, as there have been documented cases of seroconversion after occupational exposures antagonism PEP.
* Side effects ambition be encountered with medication.
* Most importantly, issues of safer ###### and how to discourage future exposures have to be addressed.
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