April 12, 2011
Every month, HIV specialist Theresa Mack, M.D., M.P.H. -- an associate medical director St. Luke's Roosevelt Morningside Clinic, a comprehensive HIV-care center in Harlem, N.Y. -- will answer your most pressing HIV/AIDS questions.
If you are concerned that you may have been exposed to HIV, see your doctor immediately about postexposure prophylaxis (PEP), a treatment that -- taken correctly -- may prevent about 80 percent of people who have recently been exposed to the virus from becoming infected with it.
The Centers for Disease Control and Prevention recommends PEP for people accidentally exposed to HIV outside of a health-care setting, medical professionals who have suffered a needle-stick injury and newborns of HIV-positive mothers.
I recommend PEP to any person recently exposed to the virus. For example, you may have been exposed to HIV if you had sex without a condom, the condom broke during sex, you were sexually assaulted, or you shared needles while tattooing or shooting drugs.
But PEP is not meant to encourage unsafe sexual practices. It is not a license for reckless behavior with the goal of obtaining the antiviral medications the next day. PEP is intended only as a preventive tool for accidental exposure to HIV. It must not replace safer-sex practices such as using a condom, knowing your partner's status and practicing mutual monogamy.
It is critical that you initiate PEP within two to 72 hours after potential exposure to HIV -- generally considered the window period during which the virus travels from the initial point of contact to the bloodstream. PEP attempts to destroy the virus before it enters your bloodstream. Once it enters your blood, you will become infected.
PEP treatment consists of taking a combination of HIV-fighting antiretroviral medications for four straight weeks (28 days). (You can read about these medicines and their potential side effects here.) If you begin treatment within the two- to 72-hour window, there is a good chance -- up to 80 percent -- that the drugs will keep you from becoming infected with HIV. However, the longer you wait to begin the treatment, the less effective PEP will be.
The number of pills you must take each day depends on which medicines your health-care provider selects. The doctor will prescribe a combination that is right for you. All have potential side effects -- such as nausea, headaches, vomiting, fatigue and diarrhea -- but your medical provider can help you manage those symptoms.
The medications used for PEP can be very expensive. Medicaid, Medicare and commercial insurance plans will usually cover the full four weeks of treatment, but each state has different regulations. The total out-of-pocket cost typically runs from $600 to $1,000. If you do not have insurance and cannot afford the medicines, there may be programs in your area that can help. Contact your local department of health for more information.
As told to Tomika Anderson, a freelance writer based in Brooklyn, N.Y.