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How Do I Take nPEP, And What Side Effects Are There?

The emergency prophylactic medication for HIV, nPEP, is not just a one-time pill. The regimen follows a continuous schedule that needs to be adhered to religiously for it to be effective.


Post-exposure Prophylaxis, or nPEP for short, is a continuous 28-day course taken after a high-risk exposure to HIV. The drugs in the nPEP regime need to be taken every day simultaneously, or the medications would not reach desirable levels in your blood. Stopping abruptly or skipping doses can result in decreased efficacy or complete treatment failure.


You must contact your doctor immediately once a high-risk exposure to HIV has occurred. Your doctor will evaluate the situation, order some tests, and determine if you need to start nPEP.


HOW DO I TAKE nPEP?

The nPEP regime consists of Emtricitabine and Tenofovir (both drugs combined in one pill) and the third drug of choice from either Raltegravir or Dolutegravir. The regime consists of taking two pills daily at the same time for 28 days after HIV exposure. Truvada and Descovy are both FDA-approved regimens, Descovy is FDA-approved for MSM HIV prevention. Once started, it is not recommended to skip doses or stop taking the medications altogether because that can reduce the regimen's efficacy in preventing an HIV infection. 


If you miss a dose in your nPEP regimen, you should take it as soon as you remember. However, if you remember missing a dose close to the next dose, it is recommended that you take the next dose at the right time instead. Double dosing with nPEP is not recommended as it might cause unexpected side effects due to high drug concentrations in your blood.


As mentioned above, the post-exposure prophylaxis treatment for HIV is an emergency regimen taken after a high-risk exposure to HIV has occurred. A high-risk exposure to HIV could mean having unprotected sex with a partner whose HIV status is unknown, condom breakage during sex (especially anal sex), and or coming into contact with another person's blood or other bodily fluids.


If any of these situations apply to you, you might be eligible for taking nPEP:

  • You’re a victim of sexual assault
  • You’ve just had unprotected intercourse (anal or vaginal) with someone whose HIV status is unknown
  • You’ve had unprotected intercourse with an HIV-positive person
  • Your condom broke during a sexual intercourse
  • You have come into contact with someone else’s blood or other bodily fluids
  • You have shared an injecting needle with someone else


If any of the above situations have occurred to you, you must contact your healthcare provider as soon as possible. Your doctor will take a detailed history of your sexual contact and your sex life in general. Your doctor will then order HIV diagnostic investigations and start you on nPEP immediately. nPEP is best when taken within the first 24 hours of a high-risk contact. However, if the first 24 hours are missed, nPEP can still be taken within 3 days, or 72 hours, of coming into contact with HIV. If, however, 3 days have passed, nPEP would not provide adequate protection against HIV.


WHAT ARE THE SIDE EFFECTS OF nPEP?

Like any other medication regimen, nPEP has its side effects as well. Side effects with nPEP depend on the choice of drugs in your regimen. Your healthcare provider will evaluate your health status and choose the best medications to include in your regimen. 


Common side effects include GIT disturbances, headaches, and general fatigue. These side effects are usually mild and resolve on their own without any intervention. Serious side effects include muscle aches, loss of appetite, fever, rash, vivid dreams, insomnia, joint pain, and anemia.


Side effects with nPEP usually appear a few days after starting this regimen. These side effects usually go away on their own after a few days. It is important to continue taking nPEP even if you do experience any of these side effects. Talk to your healthcare provider about alternative medication if side effects do not resolve on their own. 


Another important thing to keep in mind is that most of these side effects are reported by HIV-positive patients who took these drugs for long periods. However, since the nPEP regimen lasts for only 28 days, it is highly unlikely that people taking nPEP would develop any serious long-term complications like liver failure.


HOW EFFECTIVE IS nPEP?

While nPEP is extremely effective in preventing an HIV infection, it does not guarantee 100% protection against the virus. Studies looking into the drug's efficacy conclude that nPEP provides up to 80% protection against the virus. This result means that 20% of people involved in the study who took nPEP still developed an HIV infection. However, these results might be affected due to multiple factors, such as low adherence to nPEP and the possibility of ongoing HIV exposure. The preventative treatment regimen may provide much higher protection against the virus if adhered to regularly and taken properly, as explained by the doctor.


It is also important to consider that while strong adherence to the drug regimen provides excellent protection against HIV, there is still much more that you can do on your part to reduce your risk of acquiring HIV. Lowering your risk of exposure is the first and foremost thing you can do to minimize your chances of acquiring the virus. Practicing safe sex with your sexual partner(s), keeping your sexual partners to a minimum, getting tested for HIV regularly, and not sharing anyone's hygiene products will provide excellent added protection along with nPEP against HIV.


ARE nPEP AND PrEP THE SAME THING?

Although both medication regimens are used for the same purpose, to prevent HIV infections, PrEP and nPEP are not the same things. These medication regimens are very different in their indications, choice of medications, and treatment schedule. 


PrEP is a pre-exposure prophylactic medication regimen used to prevent HIV infections in people who have not yet been exposed to HIV. The key here is that PrEP is taken even before exposure to HIV occurs, which is the main difference between PrEP and nPEP. 


Another difference between PrEP and nPEP is the drugs used in both these regimens. Truvada is often used in PrEP regimens. Truvada is a combination of Tenofovir and Emtricitabine. Although both of these drugs are also used in the nPEP regimen, the nPEP regimen has many more options and a third drug in the daily schedule.


PrEP, unlike nPEP, is given to people who aren't yet exposed to HIV but carry a very high risk of doing so. These people include:

  • Those with multiple sexual partners
  • People who engage in unprotected sexual intercourse frequently
  • People living with an HIV-positive partner
  • Men who have anal sex with other men
  • IV drug abusers
  • Healthcare professionals who come into contact with HIV-infected bodily fluids frequently
  • Transactional sex workers


Talk to your healthcare provider about your concerns if you are unsure whether you need nPEP or PrEP.


WHERE CAN I GET nPEP?

You can get nPEP from your doctor's office. Your doctor is the first person you should see immediately after a high-risk exposure to HIV, and he can start you on a full 28-day course of nPEP after evaluation. Your doctor will also explain how to take the medication properly and any complications or side effects that you should be aware of while on these drugs.


You can also get a course of nPEP from the emergency rooms. Emergency rooms will provide you with an immediate dose of nPEP after your HIV exposure and provide doses for the coming few days. You will then have to get yourself checked with a physician and get a prescription for nPEP at the earliest.


Other places where you can get nPEP in the United States include health clinics, pharmacies, and Planned Parenthood Centers.


WILL nPEP CURE ME OF HIV?

No. nPEP does not cure HIV. It only works to protect you from an infection after you have been exposed to the virus. It is important to understand that nPEP is not a curative treatment for HIV but only a preventative measure against infection after a high-risk exposure. Once an infection develops, nPEP does not provide any protection against the virus whatsoever. Anti-retroviral medication is then given to HIV-positive patients rather than nPEP. 


Another important thing to consider is that nPEP, even when taken on time, does not guarantee 100% protection against the development of an HIV infection. While taking nPEP within 24 hours of exposure, or 3 days maximum, provide strong protection against the development of an HIV infection, there is no guarantee that an infection will not develop.


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