PEP for HIV: Protection During Treatment and Beyond

Regarding HIV PEP (Post-Exposure Prophylaxis)

Hello doctor, I have been experiencing some issues recently, so I am currently taking PEP.
I would like to ask if engaging in sexual intercourse during the PEP treatment period with a partner who is a carrier would provide protection, or would I need to restart the 28-day regimen? I am taking Dolutegravir, which I have heard can be used as both PrEP and PEP.
However, I only have 4 pills left and will finish the 28-day course soon.

Dàn gāo, 20~29 year old female. Ask Date: 2023/12/13

Dr. Liao Zhongxin reply Internal Medicine

1.
The difference between PrEP and PEP lies in their use for pre-exposure or post-exposure prophylaxis.

2.
Additionally, I provide the 2-1-1 prevention method for your reference.

Reply Date: 2023/12/13

More Info

Post-Exposure Prophylaxis (PEP) is a critical intervention for individuals who may have been exposed to HIV. It involves taking antiretroviral medications within 72 hours after a potential exposure to the virus, and it is most effective when started as soon as possible. The medication you are taking, Biktarvy, is indeed used for both PEP and PrEP (Pre-Exposure Prophylaxis), but it is essential to understand how it works and what precautions you should take during your treatment.

Firstly, PEP is designed to prevent HIV infection after a potential exposure. If you are taking PEP as prescribed, it significantly reduces the risk of contracting HIV. However, it is crucial to note that PEP is not 100% effective. The effectiveness can be influenced by several factors, including how soon after exposure you started the medication, adherence to the regimen, and whether you engage in high-risk behaviors during the treatment period.

Regarding your question about engaging in sexual activity while on PEP, if you have unprotected sex with someone who is HIV positive, there is still a risk of transmission, even if you are taking PEP. The medications work to inhibit the replication of the virus, but they do not provide immediate protection. Therefore, if you engage in unprotected sex during the PEP treatment, it is advisable to continue taking the medication for the full 28 days as prescribed. You should not stop taking PEP prematurely, as this could increase your risk of infection.

In your case, since you mentioned that you have only a few pills left and are nearing the end of your 28-day course, it is essential to complete the treatment. If you have concerns about potential exposure during this time, you should discuss this with your healthcare provider. They may recommend additional testing or a follow-up plan to ensure your safety.

Additionally, it is important to understand that while PEP can significantly reduce the risk of HIV infection, it does not protect against other sexually transmitted infections (STIs). Therefore, practicing safe sex, including the use of condoms, is crucial even while on PEP.

After completing the full course of PEP, it is recommended to get tested for HIV approximately 4 to 6 weeks after the last dose, and again at 3 months to confirm your status. This follow-up testing is essential because it can take time for HIV to be detectable in the body after exposure.

In summary, while PEP is a powerful tool in preventing HIV infection after potential exposure, it is not infallible. Engaging in unprotected sex while on PEP can still pose a risk, and it is vital to adhere to the full treatment course and follow up with appropriate testing. Always consult with your healthcare provider for personalized advice and to address any concerns you may have during your treatment.

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