Pep: Can Early HIV/AIDS Infections Be Prevented?

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By Sadaf Qadir

With 36.7 million people living with the HIV infection globally as of 2015, it is clear that HIV has a huge impact in global healthcare [1]. But what is HIV?

HIV stands for ‘Human Immunodeficiency Virus’ and, true to its name, attacks the immune system [3]. HIV targets immune cells called T-cells for destruction which results in a weakened immune system [4]. When the T-cell count falls very low, a person is said to have Acquired Immune Deficiency Syndrome or AIDS; however, if treatment is managed, a person may avoid getting to this stage [5].

HIV is spread via bodily fluid contact which includes sexual activity, needle sharing, and breast milk [6]. New HIV infections occur due to transmission through these actions [6]. While there is no cure, the treatment option is taking antiretroviral therapy (ART) drugs, which reduce the chances of advancing to AIDS and prolongs HIV infected people’s lifespans [2]. However, prevention methods through education and awareness have played a major role in decreasing the number of new infections.

In recent years, a new drug called Post-Exposure Prophylaxis (PEP) has been developed as a prevention method for people who suspect they have come in contact with HIV [7]. PEP involves taking ART drugs within 72 hours of exposure, every day for 28 days [8]. As of 2005, the medication is available to anyone who can access and afford it [8]. While the pill is expensive, ranging from $600 to $1,000 per 28-day prescription, it is possible for healthcare providers to apply for free PEP medications through the manufacturer [7].

PEP has been gaining more interest over the years as a prevention method and is used as an emergency option especially for healthcare workers [8]. However, it still has its limitations. PEP does have side effects including nausea, headache, fatigue, and general feeling of illness [8]. It is also not 100 percent effective [7, 8]. In healthcare workers, HIV infections were reduced by 79 percent post-exposure to the virus [8]. However, because the drug is still fairly new, there are no  conclusive data on its implications in non-healthcare settings [8]. Additionally, concerns have been raised about PEP’s potential to be considered as the “morning after” pill for HIV/AIDS when it should be used as an emergency prevention method and not as a safety net for those who want to continuously engage in risky behavior [7]. As these drugs are taken more often, drug resistance can occur and different types and amounts are then required [8]. PEP has also led to the development of Pre-Exposure Prophylaxis, which may be an option for those who frequently are exposed to HIV (e.g. healthcare workers in Africa) [10].

As more research is conducted and more people around the world start considering PEP, it will become easier to gauge its efficacy and potential . For now, it is useful to know that PEP is an option in case of an emergency [9].

References:

1)   http://www.cdc.gov/hiv/basics/statistics.html

2)     https://www.aids.gov/hiv-aids-basics/hiv-aids-101/global-statistics/

3)     http://www.cdc.gov/hiv/basics/whatishiv.html

4)   Cummins, J., W. Nathan, and A. D. Badley. 2014. Making Sense of How HIV Kills Infected CD4 T Cells: Implications for HIV Cure. Molecular and Cellular Therapies 2: 20.

5)     https://www.aids.gov/hiv-aids-basics/hiv-aids-101/what-is-hiv-aids/index.html

6)     http://www.cdc.gov/hiv/basics/transmission.html

7)     http://www.cdc.gov/hiv/basics/pep.html

8)     http://www.aidsinfonet.org/fact_sheets/view/156

9)     https://www.aids.gov/hiv-aids-basics/prevention/reduce-your-risk/post-exposure-prophylaxis/

10)  http://www.cdc.gov/hiv/basics/prep.html

 

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