Continued...

Considerations in initiating anti-retroviral therapy for PEP
Physicians considering the initiation of anti-retroviral therapy in an attempt to reduce the risk for HIV infection in an exposed person should take the following steps in consultation with an expert in the use of anti-retroviral agents:



Provide counselling and obtain informed consent. Because post-exposure prophylaxis is an experimental therapy of unproven efficacy, informed consent should be obtained and recorded in the medical charts of all persons prescribed anti-retroviral agents following non-occupational exposure. Such consent should document the patient's understanding of


Persons younger than 16 years at the time of exposure should be evaluated (before therapy is initiated) by paediatricians, family physicians or other clinicians expert in the specific medical needs, consent issues and other factors involved in their treatment, including the use of anti-retroviral medicines for children and adolescents.

If anti-retroviral therapy is used, drug toxicity monitoring should include a complete blood count and renal and hepatic function tests when therapy is initiated and again 2 week after the patient begins to take the medications. It is possible that anti-retroviral therapy during early HIV infection could benefit the patient by reducing the initial level of viral replication (i.e. the set point) and decreasing the extent of lymph node infiltration. Thus, for patients with the highest risk exposures, health care providers may consider continuing therapy until HIV test results are received from a specimen drawn after 28 days of treatment. Patients should be monitored for signs and symptoms of acute HIV infection during therapy. If such conditions develop, the patient should be tested for HIV (p²⁴ antigen, HIV viral load assays) during their 4-week course of therapy with confirmation by standard HIV antibody tests. Persons who become infected while taking anti-retroviral therapy should be advised to continue taking the medication pending transfer to a health care provider who specialises in long term HIV care.

There has been apprehension that availability of PEP may cause people to stop practising safe sex or stop safer needle use. HIV negative persons may wonder, "why bother with condoms or clean rig" when therapy to prevent HIV is available. HIV transmission could increase with these attitudes. So it must be emphasized through media campaign and counselling that no PEP therapy is 100% effective, it has its own side effects and it needs strict adherence. Hence the stress should be on preventive measures through safe sex and safer needle use.

Last updated on 01-06-2005 Vol 2 Issue 6 Art # 27

How to cite this url