► Pep, what's it like doing it?

[vikdoc]

I'm not sure this is the right forum in which to discuss PEP (Post Exposure Prophylaxis), but the question I'm raising is linked to what its like doing it. If anyone wants a discuss on whether to do it at all, then perhaps that could happen on another forum.

For those who don't know what I'm talking about PEP is a strategy to prevent HIV infection after an unsafe encounter. It could be an sexual encounter without condoms with a partner whose status you're not sure about, or a condom that broke, or perhaps exposure in a hospital (needlestick, which is getting pricked by a syringe that might not be clean) and so on.

In such cases its been shown that by taking the regular anti HIV medication as soon as possible (within 72 hours latest) for about a month you have a reasonable chance of preventing an HIV infection. I'm not sure what the reason is (and if anyone knows, please post), but its established enough to be done regularly in places like hospitals.

But everyone who's done it say that it should NOT be thought of as an easy 'morning after' option. For one, outside a hospital in India its not easy getting a doctor to prescribe the medicines since most have not heard of PEP. Even the HIV/AIDS groups don't seem to know much about it, or see it as an extreme, unlikely option.

The other problem is that the drugs are strongly toxic so that taking them is hardly a picnic. Apparently one will go through a month of feelin nauseous and experience other side effects. But that's exactly what I'm writing to ask: could someone who's done it tell us what its like? How bad are the side effects? Would you do it again? And would you do it in a case where you don't know if the other guy is +ve, but you're not sure?

[vikdoc]

This information from Aditya has already been posted in another thread on this forum, but since its important and relevant to this thread I'm posting it here as well:

PEP is vital. If you have a doubt that you may have exposed yourself to infection, it is advisable to start PEP immideately. The advisable time is within 24 hours [in protocols developed for healthcare providers]. However some say that though with decreasing efficacy, it may still be commenced within upto 72 hours of infection. [in other words, soonest is best]. After 72 hours, its usually pointless.

But PEP is not the morning after pill for gay men. Its success is TOTALLY DEPENDENT on adherence to the regime. And those who think that it is a morning after pill usually will not adhere for the month to the drugs. Its psychological. The drugs **** yu up so much that enjoying sex becomes an impossibility. And those who want a morning after pill are really doing it because they want to have unprotected SEX. So ultimately they do not adhere, they end up spending a ton of money, and they get NO BENEFIT whatsoever.

As to the debate, we must realise that PEP was actually developed as a protocol for exposure in medical settings where doctors or healthcare
providers may have exposed themselves as part of their job. It was adopted for gay men since it had some proven efficacy. Nice thought, that. But I personally feel that it should be given only to those gay men who habitually practice safe sex and may have suffered accidental exposure to infection [say by way of a torn condom].

It is certainly not for those who are habitually irresponsible enough to not practice safe sex and then want to lean on PEP for a sense of protection.

I want to share an actual case I know of. A gay friend of mine in San Francisco kept ARVs in his medicine cabinet, to pop pills after barebacking sex. He certainly did not adhere to any regimen. Just arbit self medication. He did get infected. And the worst thing is that just one year after testing positive to HIV, he had to be put on ARVs and today three years down the line, he is already resistant to first line ARV and has had to be put on second line ARVs. In America, this costs a bomb.

This is not a a scientifically proven claim, and I am not qualified to make such a claim either, but somehow that nagging feeling persists that his fast forward progression of infection has something to do with all those pills he popped earlier "the day after".

Best, Aditya B

[Rish]

Vik,

Could you mention what are the effects of the meds - you have not mentioned them? Are the responses to the medication different from person to person?

There is someone who is reading this and would like to know but doesn't want to ask on the forum... (Aside: people, please write in with your own queries - there is no way any one is going to be labelled for just writing in on the forums!!)

[vikdoc]

I'll try and get someone who's done PEP to give an idea of what its like. With the one friend of mine who took it, he was nauseous and tired for most of the month he was taking it.

Which is partly why one has to have a realistic ability to judge how likely you are to stick to it, if you start taking it. Because as Aditya has mentioned, and I have since confirmed from an informed source, taking PEP in an incomplete way can probably be worse in the long run than not taking it all.

There does seem to be a link between taking PEP - specifically one drug, I've forgotten the name - in an incomplete way and the body building up resistance to that drug if you do eventually get HIV and need to start taking it.