I might have been exposed to HIV, what do I do now?
Don’t panic, but act quickly. If you have been exposed to HIV, an emergency treatment known as “Post Exposure Prophylaxis” (PEP), can prevent you from becoming HIV positive. PEP is a 28 day course of anti-retroviral therapy and in order to be effective, it must be initiated within 72 hours (3 days) of exposure.
The sooner PEP is started the better chance it will prevent you from seroconverting (i.e. becoming HIV positive) To find a PEP provider near you, enter your ZIP code or City and State into the “Find A Provider” bar. Not every doctor or hospital understands or provides PEP, so check the PEPnow database to confirm that your hospital or doctor provides PEP.
When should I get PEP?
It can be confusing to know whether you need PEP or not. You may not know for certain if what you did put you at significant risk or if your sex partner even has HIV. Personnel at an emergency room, clinic or physician’s office can help you assess your risk and whether or not PEP is appropriate. If you had unprotected sex and your partner does not know his or her status, you can ask them to go to the hospital, clinic or physican’s office with you in order to get tested, if they are willing.
The following chart provides average HIV exposure risks for various different activities. It is important to note that these are just averages, and your exposure risk may be higher or lower. The chart assumes that the source patient or sex partner is HIV positive.
Risk of HIV Infection by Sexual act or Activity
(sexual act or activity)
|Average chance of becoming HIV+ per exposure to infected source|
|Blood Transfusion||9 in 10|
|Needle Sharing (for injection drug use)||13.4 per 2000 exposures|
|Receptive (bottom) unprotected anal sex||10 per 2000 exposures|
|Needle Stick||6 per 2000 exposures|
|Receptive unprotected vaginal sex||2 per 2000 exposures|
|Insertive (top) unprotected anal sex||1.3 per 2000 exposures|
|A man getting a blow job||.2 per 2000 exposures|
|A man giving a blow job to another man||.1 per 2000 exposures|
based on: MMWR (January 21, 2005 / 54(RR02);1-20)
Bottom line: It is better to be safe than sorry and if you have any doubt about the degree of risk, get advice from an experienced professional.
What will happen at the clinic or hospital?
After you have informed the triage nurse or receptionist that you might have been exposed to HIV and need PEP, you will be taken to a room to consult with a health care provider who will discuss your situation with you. If it is determined that you are at significant risk for HIV infection and are still within the time limits for PEP, some or all of the following may happen:
- You will be given a starting dose of antiretroviral drugs
- You will take a baseline HIV test (to determine if you are already infected)
- The physician may order a Hepatitis B antibody test to make sure you have significant immunity to Hepatitis B, if not he or she may give you a Hepatitis B vaccine
- The physician may order liver function and other necessary blood tests to make sure you can safely take antiretroviral drugs
- You will be given a prescription for 28 days of antiretroviral therapy
- You will be scheduled for a follow up appointment
Some hospitals and clinics might also give you a “starter pack” of several days’ anti-retroviral therapy so that you can continue your therapy in the event that you cannot get your prescription filled rapidly.
What does PEP treatment consist of?
PEP consists of a 28 day course of Highly Active Antiretroviral therapy or HAART. HAART is “highly active” because it consists of two or more different antiretroviral drugs. Antiretroviral drugs are medicines that slow down or stop HIV from replicating inside the body (HIV is a type of virus known as a “retrovirus“). HAART is the therapy that many HIV positive people use to keep their infection under control. Different combinations of antiretroviral drugs, known as “cocktails”, are used in PEP. Although no single HAART cocktail has been proven to be more effective then others when used for PEP, the United States Centers for Disease Control and Prevention (CDC) recommends the following HAART cocktails for PEP:
- A combination of Efavirenz (brand name Sustiva), plus lamivudine (known as 3TC, brand name Epivir) or emtricitabine (known as FTC, brand name Emtriva), plus zidovudine (known as AZT) or tenofovir (known as PMPA, brand name Viread)
- A combination of lopinavir/ritonavir (sold in a combined form, brand name Kaletra), plus lamivudine (known as 3TC, brand name Epivir) or emtricitabine (known as FTC, brand name Emtriva) plus zidovudine (known as AZT)
Your physician may prescribe a different cocktail.
Are there side effects?
Many people experience side effects when they are on antiretroviral drugs. For many people, the side effects reduce or go away after your body adjusts to the treatment. In any case, the PEP regimen is only for 28 days, which is vastly preferable to acquiring HIV and having to take them for the rest of your life. If you stop the treatment before the full 28 day course, it may not work and you may seroconvert and become HIV positive. If side effects cause you discomfort, tell your doctor, as he or she may be able to adjust your treatment to help alleviate the side effects.