HIV PEP: Stop HIV within 72 hours of sex

HIV Testing: 20 min result, 28 days after sex

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HIV Screening Test Singapore.

HIV Screening Test Singapore: HIV (human immunodeficiency virus) screening test clinic, Singapore. Private and confidential service. Definitions, references, and latest news.

Table of Contents

• HIV
• HIV Symptoms
• HIV Test
• HIV PEP (Post-Exposure Prophylaxis)

HIV Test / HIV Testing / HIV Check / HIV Checking / HIV Screen / HIV Screening

HIV is the abbreviation for the human immunodeficiency virus, which causes the acquired immunodeficiency syndrome

HIV symptoms which may present in acute HIV infection:

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

These are nonspecific symptoms and can present with other infections; consequently, they are unreliable indicators of HIV infection.

Remember, there is no HIV cure.

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.

• 4 weeks after exposure, a negative 4th generation HIV ELISA Test "is very reassuring / highly likely to exclude HIV infection."
• 12 weeks after exposure, a negative 3rd generation HIV ELISA Test "would definitively exclude HIV infection."

References

• 2010 March 15 BASHH Statement on HIV window period

HIV ELISA (Enzyme-linked immunosorbent assay) test generations:

1. 1st generation: HIV-1 IgG antibody
2. 2nd generation: HIV-1 & HIV-2 IgG antibodies
3. 3rd generation: HIV-1 & HIV-2 IgG & IgM antibodies
   • 3 month HIV window period
4. 4th generation: HIV-1 & HIV-2 IgG & IgM antibodies and HIV p24 antigen
   • 1 month HIV window period

References

• 1st, 2nd, 3rd, and 4th Generation HIV Antibody ELISA Tests

HIV rapid test (20 minutes to results) Two types are available:

• SD Bioline HIV Ag/Ab Combo test
  • 4th generation HIV ELISA test.
  • 1 month HIV window period.
  • Recommended when exposure was 1 month or more ago
  • Fingerprick blood sampling
  • Cost/price is S$150/=.
• OraQuick® Rapid HIV-1/2 Antibody Test
  • 3rd generation HIV ELISA test.
  • 3 month HIV window period.
  • Recommended when exposure was 3 months or more ago
  • HIV oral test / HIV saliva test or Fingerprick blood sampling
  • Cost/price is S$50/=.

Note: If the clinic attendance is only for the HIV rapid test, then consultation fees are not added.

References

• SD BIOLINE HIV Ag/Ab Combo
• 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
• OraQuick ADVANCE® Rapid HIV-1/2 Antibody Test Customer Letter
• 2013 March WHO Prequalification of Diagnostics Programme PUBLIC REPORT Product: SD Bioline HIV Ag/Ab Combo
• 2012 March WHO Prequalification of Diagnostics Programme PUBLIC REPORT Product: Alere Determine HIV-1/2 Ag/Ab Combo

HIV PCR (polymerase chain reaction) NAT (nucleic acid test)

• HIV DNA (deoxyribonucleic acid) PCR(polymerase chain reaction) NAT (nucleic acid test)
• HIV RNA (ribonucleic acid) test PCR(polymerase chain reaction) NAT (nucleic acid test)

HIV Risk (2009 figures)

Estimated HIV transmission risk per exposure for specific activities and events

Sources: vaginal sex;¹ anal sex;² fellatio;^{3 2} mother-to-child;⁴ other activities.⁵

References

1. Boily MC et al. Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies. Lancet Infect Dis 9(2): 118-129, 2009
2. Vittinghoff E et al. Per-contact risk of human immunodeficiency virus transmission between male sexual partners. American Journal of Epidemiology 150: 306-311, 1999
3. Del Romero J et al. Evaluating the risk of HIV transmission through unprotected orogenital sex. AIDS 16(9): 1296-1297, 2002
4. Townsend C et al. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000-2006. AIDS 22: 973-981, 2008
5. Baggaley RF et al. Risk of HIV-1 transmission for parenteral exposure and blood transfusion. AIDS 20: 805-812, 2006
6. HIV & AIDS Information :: How transmission occurs - Estimated risk per exposure

HIV Risk (2005 figures)

Estimated per-act risk for acquisition of HIV, by exposure route*

*Estimates of risk for transmission from sexual exposures assume no condom use.
†Source refers to oral intercourse performed on a man.

References

• Estimated per-act risk for acquisition of HIV, by exposure route
• Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States

HIV risk (2002 figures)

HIV Risk Statistics (chances of getting HIV)

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 prevention / HIV PEP (post-exposure prophylaxis) 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:

1. less than 72 hours has elapsed since exposure;
   and
2. the exposed individual is not known to be HIV infected;
   and
3. the person who is the source of exposure is HIV infected or has unknown HIV status;
   and
4. mucous membrane or non-intact skin was exposed to a potentially infectious body fluid;

Prompt antiviral therapy may reduce the risk of HIV transmission by as much as 80%.

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.

References

• Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States
• HIV postexposure prophylaxis: Who should get it?

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)

References

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

TORCH

TORCH complex is a medical acronym for a set of perinatal infections (i.e. infections that are passed from a pregnant woman to her fetus), that can lead to severe fetal anomalies or even fetal loss.

T - Toxoplasmosis O - Other infections (see below) R - Rubella C - Cytomegalovirus (HHV-5) H - Herpes simplex virus (HHV-1 & HHV-2) Other agents are: Syphilis Varicella-Zoster Virus (HHV-3) HIV Coxsackievirus Parvovirus B19 Hepatitis B does not cross the placenta, but may do so during childbirth or amniocentesis.

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