who npep 28 day course

All persons offered nPEP should be prescribed a 28-day course of a 3-drug ARV regimen. Pre-exposure prophylaxis (PrEP): contact the Clinician Consultation Center at 1-888-448-7737 for clinician-to-clinician advice. Additional information on the use of dolutegravir in pregnancy.

Full Answer

Why does PEP have to be taken for 28 days?

PEP involves taking a 28-day course of anti-HIV drugs, after possible exposure to HIV. Doctors will assess your risk of HIV infection before prescribing PEP.

Is 28 days enough for PEP?

Post-exposure prophylaxis (PEP) is the use of short-term antiretroviral therapy (ART) to reduce the risk of acquisition of HIV infection following exposure. Current guidelines recommend a 28-day course of ART within 36–72 hours of exposure to HIV.

How long is the whole course of PEP treatment?

Most importantly, PEP is only taken for 28 days. In almost all cases, the benefits of HIV prevention outweigh any other risks posed by the medication.

Who can prescribe PEP?

While PEP has been shown to work, it is not 100 percent effective. Taking it does not guarantee that someone exposed to HIV will not acquire the virus. How can I access PEP? Any licensed healthcare provider can prescribe PEP.

Can I take PEP for 29 days?

There is no data to support that taking PEP for any longer than 28 days is beneficial. In exceptional circumstances the course may be extended, but does require very specific criteria to be met and consultation with an HIV specialist. Taking PEP every day for the 28 day course is what minimizes your risk most.

Can I stop PEP after 25 days?

If PEP is prescribed after 72 hours and then discontinued after 28 days, the risk of viral rebound with that inadvertent interruption in ART is significant, as is the associated risk of developing resistance to ART; therefore, this Committee stresses that PEP should not be initiated later than 72 hours post exposure.

Which test is best after PEP?

Once you have finished your course of PEP, you should take an HIV test to be sure that you are free from infection. Your Better2Know testing options include: Early Detection Screen - or HIV RNA PCR test - just 10 days after you have finished PEP.

Can I take PEP for 21 days?

Taking PEP may prevent you from becoming HIV positive. You only need to take PEP for a month (28 days). If you become HIV positive you may have to take anti-HIV treatments for a lifetime.

Can I stop PEP early?

Once you begin taking PEP, it is important to continue taking the medication as directed. Stopping or skipping doses may be dangerous. PEP is prescribed for 28 days, meaning you must take the medication each day for 28 days. Do not skip doses.

Where can I get PEP from?

The best place to get PEP is a sexual health or HIV clinic. If you need PEP over the weekend or outside of office hours, when clinics will often be closed, the best place to go is an Accident and Emergency department.

When do doctors prescribe PEP?

PEP (post-exposure prophylaxis) means taking medicine to prevent HIV after a possible exposure. PEP should be used only in emergency situations and must be started within 72 hours after a recent possible exposure to HIV.

What is the cost of PEP?

PEP is available in private clinics, where one bottle of medication (30 tablets) can cost anywhere between ₹ 2,000-4,000.

Can I take PEP for 26 days?

There is no data to show there is any difference between 26 day or 28 days of PEP, so you can easily do this with little likely impact on the efficacy of PEP. Actually, there is no data showing a difference between 21 and 28 days either – I think 28 days was chosen for practical reasons as much as anything else.

What happens if you stop PEP early?

Stopping or skipping doses may be dangerous. PEP is prescribed for 28 days, meaning you must take the medication each day for 28 days. Do not skip doses. PEP may not work correctly if taken in combination with certain medications.

What is the success rate of PEP?

Among studies assessing two-drug regimens, PEP completion rates were significantly higher for TDF-based regimens (78.4%) compared to ZDV-based regimens (58.8%).

Can I take PEP for 2 months?

Since people living with HIV take the very same medications that are prescribed for PEP for many years without significant safety issues, you should be fine with two or more PEP regimens.

How long should a patient take npep?

Health care providers should consider giving an initial prescription for 3–7 days of medication (i.e., a starter pack) or an entire 28-day course and scheduling an early follow-up visit. Provision of the entire 28-day nPEP medication supply at the initial visit rather than a starter pack of 3–7 days has been reported to increase likelihood of adherence, especially when patients find returning for multiple follow-up visits difficult.96,184 Routinely providing starter packs or the entire 28-day course requires that health care providers stock nPEP drugs in their practice setting or have an established agreement with a pharmacy to stock, package and urgently dispense nPEP drugs with required administration instructions. At the patient’s second visit, health care providers can discuss the results of baseline HIV blood testing (if rapid tests were not used), provide additional counseling and support, assess medication side effects and adherence, or provide an altered nPEP medication regimen if indicated by side effects or laboratory test results. nPEP starter packs or 28-day supplies might also include such medications as antiemetics to alleviate recognized side effects of the specific medications prescribed, if they occur. Health care providers should counsel patients regarding which side effects might occur (Table 6), how to manage them, and when to contact the provider if they do not resolve.173

What is npep guidelines?

These guidelines are intended to assist U.S. health care providers in reducing the occurrence of new HIV infections through the effective delivery of nPEP to the patients most likely to benefit. As new medications and new information regarding nPEP become available, these guidelines will be revised and published.

What was the attrition rate between the emergency department and npep follow up clinic?

Conclusion: There were significant attrition rates between the emergency department and nPEP follow-up clinic. Older patients and persons without insurance were significantly less likely to attend initial clinic for nPEP care after presenting to the emergency department. Individuals with exposure to a known HIV-positive source individual were more likely to attend their initial clinic appointment. Women accounted for the majority of nonconsensual sexual exposures and were less likely to have documented completion of their 28-day nPEP regimen.

What is a failure of npep?

In the majority of studies, failure of nPEP, defined as HIV seroconversion despite taking nPEP as recommended, was typically confirmed by a seronegative HIV enzyme-linked immunosorbent assay (ELISA) at baseline visit, followed by a positive ELISA and Western blot or indirect fluorescent antibody (IFA) during a follow-up visit.

What is nPEP in HIV?

This update incorporates additional evidence regarding use of nonoccupational postexposure prophylaxis (nPEP) from animal studies, human observational studies, and consideration of new antiretroviral medications that were approved since the 2005 guidelines, some of which have improved tolerability. New features are inclusion of guidelines for the use of rapid antigen/antibody (Ag/Ab) combination HIV tests, for revised preferred and alternative 3-drug antiretroviral nPEP regimens, an updated schedule of laboratory evaluations of source and exposed persons, updated antimicrobial regimens for prophylaxis of sexually transmitted infections and hepatitis, and a suggested procedure for transitioning patients between nPEP and HIV preexposure prophylaxis (PrEP), as appropriate.

What is occupational PEP?

The use of occupational PEP (oPEP) for case management for persons with possible HIV exposures occurring in health care settings are not addressed in this guideline; updated oPEP guidelines have been published separately.2

When should a health care provider evaluate a person for nPEP?

Health care providers should evaluate persons rapidly for nPEP when care is sought ≤ 72 hours after a potential nonoccupational exposure that presents a substantial risk for HIV acquisition.a [VI-A4]

Epidemiology and Transmission

The updated guidelines for nonoccupational exposure focus on preventing HIV after sexual transmission (consensual or nonconsensual) or from injection drug use with an infected individual. 1 In 2014, approximately 44,073 people were diagnosed with HIV in the United States.

Prevention

The best way to prevent HIV infection is to avoid exposure to the virus. Sexual abstinence from oral, vaginal, and anal sex is 100% effective at preventing HIV. 7 Other protective methods include using latex condoms appropriately during each sexual encounter and avoiding reuse of needles and sharing of injection drug equipment.

Treatment Guidelines

Initiation of Therapy: Factors for the clinician to consider when deciding whether to initiate nonoccupational postexposure prophylaxis (nPEP) include the HIV status of the potentially exposed person, the HIV status of the source person (if available), the amount of time since the exposure, the characteristics of the exposure, and the frequency of possible HIV exposures.

Monitoring and Follow-Up

HIV prevention counseling, including risk-reduction behaviors, should be provided to patients seeking care after a possible HIV exposure.

Conclusion

Pharmacists can play an integral role in the management of nonoccupational exposures to HIV by educating patients about the importance of seeking care within 72 hours of exposure and the appropriate use of nPEP. Pharmacists can work with clinicians to determine if nPEP is appropriate for a patient and to recommend the most suitable nPEP regimen.

How many people have taken npep?

However, one multisite HIV vaccine trial largely conducted in the United States has assessed nPEP use by 5,418 participants, who included men who have sex with men (94%) and heterosexual women at high risk (6%). Two percent of trial participants from 27 study sites reported having taken nPEP during the trial.

What is the purpose of nPEP?

The effective delivery of nPEP after exposures that have a substantial risk for HIV infection requires prompt evaluation of patients and consideration of biomedical and behavioral interventions to address current and ongoing health risks. This evaluation should include determination of the HIV status of the potentially exposed person, the timing and characteristics of the most recent exposure, the frequency of exposures to HIV, the HIV status of the source, and the likelihood of concomitant infection with other pathogens or negative health consequences of the exposure event.

What is nPEP in health care?

The U.S. Department of Health and Human Services (DHHS) Working Group on Nonoccupational Postexposure Prophylaxis (nPEP) made the following recommendations for the United States.

How long does it take to get a npep for HIV?

Patients who have had sexual, injection-drug--use, or other nonoccupational exposures to potentially infectious fluids of persons known to be HIV infected are at risk for acquiring HIV infection and should be considered for nPEP if they seek treatment within 72 hours of exposure.

Why should npep evaluations be confidential?

Because of the emotional, social, and potential financial consequences of possible HIV infection, clinicians should handle nPEP evaluations with the highest level of confidentiality. Confidential reporting of sexually transmitted infections and newly diagnosed HIV infections to health departments should take place as dictated by local law and regulations.

Which states have npep?

Multiple public health jurisdictions, including the New York State AIDS Institute, the San Francisco County Health Department, the Massachusetts Department of Public Health, the Rhode Island Department of Health, and the California State Office of AIDS, have issued policies or advisories for nPEP use.

Is npep a placebo controlled trial?

For ethical and logistical reasons, a randomized, placebo-controlled clinical trial of nPEP probably will not be performed. However, data are available from animal transmission models, perinatal clinical trials, studies of health-care workers receiving prophylaxis after occupational exposures, and from observational studies. These data indicate that nPEP might sometimes reduce the risk for HIV infection after nonoccupational exposures.

How long does it take for PEP to work?

You must start it within 72 hours (3 days) after a possible exposure to HIV, or it won’t work. Every hour counts!

What to do if you are taking PEP?

If you are taking PEP, talk to your health care provider if you have any side effect that bothers you or that does not go away. PEP medicines may also interact with other medicines that a person is taking (called a drug interaction).

Can you get PEP after a sexual assault?

If you’re prescribed PEP after a sexual assault —You may qualify for partial or total reimbursement for medicines and clinical care costs through the Office for Victims of Crime, funded by the U.S. Department of Justice (see the contact information for each state ).