HIV PEP | Shim Clinic, STD CLINIC SINGAPORE™

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Summary

HIV PEP | Shim Clinic, STD CLINIC SINGAPORE™: HIV transmission/infection PEP (post-exposure prophylaxis/prevention) treatment clinic, Singapore - Private and confidential service. Definitions, references, and latest news.

Description

Table of Contents

• HIV
• HIV Symptoms
• HIV Screening / HIV Test / HIV Check
  • HIV Antibody Test
    • HIV Blood Test most commonly sent to the lab
    • Rapid HIV Test
      • OraQuick® / HIV Oral Test / HIV Saliva Test
      • Determine®
    • HIV Western Blot Test (for HIV confirmation, not used for screening)
  • HIV Antigen Test
    • HIV p24 Test
  • HIV NAT (nucleic acid test) / HIV PCR Test
    • HIV DNA Test
    • HIV RNA Test
• HIV Risk
• HIV PEP (Post-Exposure Prophylaxis/Prevention)

HIV PEP (post-exposure prophylaxis/prevention) treatment can prevent you from getting an HIV infection, and turning HIV positive.

Individuals are eligible for HIV PEP Treatment if all the following criteria are met:

• exposure occurred within the past 72 hours;
• mucous membrane or non-intact skin was significantly exposed to a potentially infectious body fluid;
• the potentially exposed individual is not infected or not known to be infected with HIV;
• the source is HIV+ve or the HIV status is unknown.

For optimal efficacy, antiretroviral therapy should be started as soon as possible, ideally within 1 hour of exposure. So that you can remain HIV negative.

The medications and dosages are the same as those used for lifelong treatment of HIV patients. However, for HIV PEP treatment, it is taken for only a month.

Drugs commonly used in HIV PEP:

• Lamivudine/zidovudine (Combivir®)
  • Lamivudine (3TC®) (NRTI)
  • Zidovudine (ZDV) (NRTI)
• Lopinavir/ritonavir (Kaletra®)
  • Lopinavir (ABT-378) (PI)
  • Ritonavir (Norvir®) (PI)

• Post-exposure prophylaxis to prevent HIV infection : joint WHO/ILO guidelines on post-exposure prophylaxis (PEP) to prevent HIV infection.

HIV risk

References

1. Cardo DM, Culver DH, Ciesielski CA, et al. A Case-Control Study of HIV Seroconversion in Health Care Workers after Percutaneous Exposure. N Engl J Med. 1997;337:1485-1490.
2. Katz MH, Gerberding JL. Management of occupational and nonoccupational postexposure HIV prophylaxis. Current Inf Dis Reports. 2002;4:543-549.
3. Gerberding JL. Prophylaxis for Occupational Exposure to HIV. Ann Intern Med. 1996;6:497-501
4. Vitinghoff E, Douglas J, Judon F, et al. Per-Contact Risk of Human Immunodificiency Virus Transmision between Male Sexual Partners. Am J Epidemiol. 1999;150:306-311.
5. Peterman TA, Stoneburner RL, Allen JR, et al. Risk of Human Immunodeficiency Virus Transmission From Heterosexual Adults With Transfusion-Associated Infections. JAMA. 1988;259:55-58. [Erratum. JAMA. 1989;262:502]
6. Kaplan EH, Heimer R. A Model-Based Estimate of HIV Infectivity via Needle Sharing. J Acquir Immune Defic Syndr. 1992;5:1116-1118.

HIV symptoms which may present in acute HIV infection:

• Fever
• Malaise
• Myalgia
• Rash
• Headache
• Night sweats
• Sore throat
• Lymphadenopathy
• Arthralgia
• Nasal congestion

HIV Test

The HIV window period is the time from HIV infection until a HIV Test can detect any change. Within the HIV window period, the HIV Test would be negative. During this period, the HIV viral load is extremely high, thus making the person highly infectious.

OraQuick® rapid HIV test cost/price is S$60/=. No additional consultation fees are charged if the clinic attendance is only for this test.

References

• LIST OF RAPID HIV TEST KITS REGISTERED WITH THE HEALTH SCIENCES AUTHORITY (HSA) FOR USE IN MEDICAL CLINIC SETTINGS
• OraSure OraQuick® Rapid HIV-1/2 Antibody Test
• 1st, 2nd, 3rd, and 4th Generation HIV Antibody ELISA Tests

CD4 count

• Used in HIV follow up management
• Cost SG$169/=
• Results return in 1 week.
• CD8 count is also available separately at the same price.

Sexual risk (of STD/HIV/pregnancy), and what you can do before and after exposure.

References

• HIV PEP - Wikipedia, the free encyclopedia
• HIV PEP: Definition from Answers.com
• HIV PEP - definition of HIV PEP in the Medical dictionary - by the Free Online Medical Dictionary, Thesaurus and Encyclopedia.
• WHO | WHO and HIV
• CDC HIV

HIV post-exposure prophylaxis programmes in the developed and developing world: can we learn from each other?
Thu, 15 Dec 2011 05:00:00 +0100 | International Journal of STD and ----
In an audit of HIV post-exposure prophylaxis (PEP) programmes in Blantyre, Malawi, and Liverpool, UK, a striking common deficiency was poor attendance of follow-up visits and of HIV testing to determine efficacy of PEP. Causes of poor follow-up after PEP need to be explored in both settings. (Source: International Journal of STD and ----)

A narrative study of exposures to potentially infected body fluids referred to a regional infectious diseases unit: Category: Scientific free paper
Fri, 25 Nov 2011 11:05:46 +0100 | Journal of Infection
Exposure to potentially infected body fluids is a significant occupational hazard for health care workers (HCW). While those not involved in health care work encounter this hazard less frequently, they remain at risk to exposures such as injuries from discarded needles and during assaults. Such exposures, particularly to blood, carry the potential for transmission of infection, most notably hepatitis B, C and HIV, although such events are rare. They are also the source of considerable distress and can result in long-term psychological sequelae. Appropriate initial first aid management of the injury is likely to reduce incidence of transmission and specific measures such as hepatitis B immunoglobulin (HBIG) and vaccination and HIV post-exposure prophylaxis (PEP) can prevent transmission of ...

Use of HIV PEPSE and Hepatitis B vaccine following the introduction of a SARC
Fri, 28 Oct 2011 11:14:23 +0100 | Journal of Forensic and Legal Medicine
Abstract: Adherence to local guidelines on the use of HIV post exposure prophylaxis (PEP) and hepatitis B vaccine following sexual assault was evaluated by means of audit. Forensic Medical Examiners (FMEs) were asked to complete an audit form after conducting sexual offence examinations at Gloucester Sexual Assault Referral Centre (SARC).Only one HIV PEP pack was prescribed during the six and a half month audit period. Examination of the SARC records of the allegations made by complainants did not reveal any high-risk cases involving a failure to offer HIV post-exposure prophylaxis following sexual exposure (PEPSE).The majority of the examinations performed at the SARC were carried out by trained sexual offence examiners (SOEs). The audit indicates that these SOEs were considering the appr...

Gilead granted NCINIs rights by Boehringer
Sun, 09 Oct 2011 18:10:49 +0100 | Pharmaceutical Technology
Gilead Sciences has received exclusive worldwide rights to research, develop and commercialise Boehringer Ingelheim's novel non-catalytic site integrase inhibitors (NCINIs) for HIV.Post to:Delicious  Digg  reddit  Facebook  StumbleUpon   (Source: Pharmaceutical Technology)

Preventing Human Immunodeficiency Virus Infection Among Sexual Assault Survivors in Cape Town, South Africa: An Observational Study
Mon, 07 Feb 2011 22:26:26 +0100 | ---- and Behavior
We describe 131 South African sexual assault survivors offered HIV post-exposure prophylaxis (PEP). While the median days completed was 27 (IQR 27, 28), 34% stopped PEP or missed doses. Controlling for baseline symptoms, PEP was not associated with symptoms (OR = 1.30, 95% CI = 0.66, 2.64). Factors associated with unprotected sex included prior unprotected sex (OR = 6.46, 95% CI = 3.04, 13.74), time since the assault (OR = 1.33, 95% CI = 1.12, 1.57) and age (OR = 1.30, 95% CI = 1.08, 1.57). Trauma counseling was protective (OR = 0.18, 95% CI = 0.05, 0.58). Four instances of seroconversion were observed by 6 months (risk = 3.7%, 95% CI = 1.0, 9.1). Proactive foll...

Audit of emergency department assessment and management of patients presenting with community-acquired needle stick injuries.
Tue, 01 Feb 2011 00:00:00 +0100 | Australian Health Review
Conclusion. We have identified groups that are at high risk of CANSI, including young males, security workers and cleaners. In the majority of cases protection against hepatitis B was inadequately provided, and a substantial proportion had inadequate baseline assessment and documentation. A guideline is suggested that may be used to improve these deficits. What is known about this topic? Occupationally acquired needle stick injury guidelines are well established, but no guidelines currently exist for community acquired needle stick injuries (CANSI) which may require different risk stratification, assessment and management. Management of CANSI in Emergency Departments has not been well described. What does this paper add? An audit of Emergency Department management of community acquired nee...

Blood and Body Fluid Exposures Among US Medical Students in Botswana
Tue, 30 Nov 2010 07:06:30 +0100 | Journal of General Internal Medicine
Discussion  Our intervention was associated with a decrease in needlestick exposures. Medical schools should consider training to reduce exposures abroad. Content Type Journal ArticleDOI 10.1007/s11606-010-1586-4Authors Jessica S. Merlin, Hospital of the University of Pennsylvania, Division of Infectious Diseases, Philadelphia, PA USAGail Morrison, University of Pennsylvania School of Medicine, Philadelphia, PA USAStephen Gluckman, Hospital of the University of Pennsylvania, Division of Infectious Diseases, Philadelphia, PA USAGregg Lipschik, Penn Medicine Clinical Simulation Center, Philadelphia, PA USADarren R. Linkin, Hospital of the University of Pennsylvania, Division of Infectious Diseases, Philadelphia, PA USASarah Lyon, Division of Pulmonary Critical Care, Hos...

Nonoccupational HIV Post-exposure Prophylaxis: A 10-year Retrospective Analysis
Thu, 25 Nov 2010 04:00:00 +0100 | Medscape Pulmonary Medicine Headlines
After potential exposure to HIV, how should prophylactic antiretroviral therapy be administered? HIV Medicine (Source: Medscape Pulmonary Medicine Headlines)

Nonoccupational HIV post-exposure prophylaxis: a 10-year retrospective analysis
Thu, 25 Mar 2010 00:00:00 +0100 | HIV Medicine
We conducted a retrospective analysis of administration of nonoccupational HIV post-exposure prophylaxis (nPEP) in a single centre where tracing and testing of the source of exposure were carried out systematically over a 10-year period. Files of all nPEP requests between 1998 and 2007 were reviewed. Characteristics of the exposed and source patients, the type of exposure, and clinical and serological outcomes were analysed. nPEP requests increased by 850% over 10 years. Among 910 events, 58% were heterosexual exposures, 15% homosexual exposures, 6% sexual assaults and 20% nonsexual exposures. In 208 events (23%), the source was reported to be HIV positive. In the remaining cases, active source tracing enabled 298 HIV tests to be performed (42%) and identified 11 HIV infections (3.7%). nPE...