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    Home > Active Ingredient News > Infection > The story behind the block What should HIV post-exposure prophylaxis do?

    The story behind the block What should HIV post-exposure prophylaxis do?

    • Last Update: 2022-06-12
    • Source: Internet
    • Author: User
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    Only for medical professionals to read and refer to keep in mind! PEP must be done within 72 hours! Human immunodeficiency virus (HIV) infection is one of the greatest public health problems facing the world
    .

    In recent years, with the efforts of the Chinese government and institutions from all walks of life, China's AIDS prevention and control work has achieved initial results: blood transfusion transmission has been basically blocked, injection drug use transmission and mother-to-child transmission have been effectively controlled [1].
    With the opening of "sexual concept", sexual transmission has become a more important transmission route, so HIV post-exposure prophylaxis (PEP) after high-risk sexual behaviors has become a problem that medical workers need to pay more attention to
    .

     PEP refers to the method of taking specific antiviral drugs within 72 hours to prevent HIV infection by people who have not yet been infected with HIV after having a susceptible behavior with HIV-infected persons or persons whose infection status is unknown [2]
    .

    So how exactly should PEP be implemented? What are the points to pay attention to? Dr.
    Hong Ke from Wuhan Jinyintan Hospital shared with us a typical PEP case, let’s take a look at the new inspiration it brings~ Case review▌Basic situation Male, 29 years old; male-male oral sex (with ejaculation in the mouth) , Wearing a condom for anal sex for 9 hours.
    Afterwards, the other party tested positive for HIV test strips and came to the hospital after consulting HIV blocking treatment
    .

    Past medical history: No special medical history, no history of drug and food allergy, and 5-year history of MSM
    .

    Physical examination: no obvious positive signs
    .

    ▌PEP applicability assessment 1.
    Applicable population assessment: adult males, with full capacity, in line with PEP standards 2.
    Exposure time assessment: HIV exposure occurred within 9 hours, less than 72 hours, meeting the basic requirements of post-exposure prophylaxis 3.
    Exposure Risk assessment Exposure source analysis: The other party tested positive for HIV test strips and was suspected of HIV infection, and the other party’s HIV treatment status was unknown.
    Behavioral risk assessment: During oral sex, no condom was worn, and there was contact with the other party’s semen.
    The oral surface was mucous membranes.
    The oral mucosa is incomplete, and the transmission route is established; the patient is receiving anal sex, wearing condoms throughout the process, no body fluid exchange, and the transmission route is not established Combined with the above results, it is determined that there is a risk of HIV exposure, and it is decided to initiate PEP▌PEP initiation 1.
    Sign the informed consent form (Conform to the conditions of the subjects, accept and sign the informed consent, and follow up for a total of 12 weeks)
    .

    2.
    Laboratory tests: 3.
    Medication regimen: Prescription: Bikorenol tablets (BIC/FTC/TAF), one box, one tablet orally, once a day, orally for 28 days ▌PEP follow-up on the second day after HIV exposure Week, 4th, and 12th weeks, follow-up visits to this clinic are required, and relevant tests are conducted; in the 12th week, the examination data of the consultants are supplemented, and the "Wuhan AIDS Non-occupational Exposure Case Registration Form" is completed
    .

    In the 4th week, the liver and kidney function were reexamined, the blood routine was normal, and the HIV antibody was negative; in the 12th week, the HIV antibody was negative again, and the syphilis and hepatitis C antibodies were negative, and the preventive treatment was successful
    .

    The case doctor introduced Hong Ke, deputy chief physician, deputy director of the AIDS Department of Wuhan Jinyintan Hospital
    .

    Member of the Infectious Diseases Hospital Management Branch of the Chinese Hospital Association, member of the Tuberculosis-related Diseases Professional Committee of the Tuberculosis Branch of the Chinese Medical Association, and member of the Wuhan Preventive Medicine Association's STD and AIDS Professional Committee.
    He has participated in 4 national scientific research studies and published more than 10 academic papers, including SCI 5 articles
    .

    Case summary "China AIDS Diagnosis and Treatment Guidelines (2021 Edition)" defines PEP as a person's contact with potentially HIV-infectious blood, tissue, virus extracts or other body fluids through damaged skin, mucous membranes and incomplete skin, and Precautions taken to block infection with antiretroviral drugs
    .

     In this case, the specific measures of PEP are three key: ① Risk assessment: assess the applicable population, including whether the exposure time of HIV is within 72 hours, judging the infection status of sexual partners, and assessing whether body fluids come into contact with mucous membranes through the mouth and other parts
    .

    ②Initiate treatment: After assessing the risk of HIV exposure, immediately block with medication
    .

    ③Finally, regular follow-up is carried out
    .

     When choosing a drug, you can consider Bikerenprenor tablets, which can quickly inhibit the virus and have good safety
    .

    The drug is a new three-in-one compound drug for HIV, containing bictegravir 50mg/emtricitabine 200mg/ tenofovir alafenamide 25mg, bictegravir tablets are powerful backbone drugs and innovative integrase inhibitors.
    The antiviral triple single-piece preparation is currently the only single-piece blocking regimen recommended by the "Chinese AIDS Diagnosis and Treatment Guidelines (2021 Edition)
    .
    "

    Case inspiration ■ 1.
    In the process of PEP implementation, why must it be carried out within 72 hours? What should I do if it exceeds 72 hours? During the implementation of PEP, it needs to be carried out within 72 hours, because animal experiments have found that preventive treatment after 72 hours has a poor effect, and the success rate is the highest within 24 hours, so in principle, it is as early as possible
    .

     ■ 2.
    What are the advantages of being a monolithic blocking solution (Bike Emprena)? As a single-tablet blocking solution, the advantages of Bikerenpron tablets are that they are easy to take, 1 tablet/day, less side effects, less demanding on bone and renal function, less interaction between drugs, more suitable for patients with underlying diseases At the same time, the effect of PEP is good, and the pharmacoeconomics is better, which is more cost-effective than TDF/FTC+DTG
    .

     Senior Doctor Prof.
    Ruan Lianguo Comments Comments on Doctors Introduction Ruan Lianguo Professor Ruan Lianguo, Wuhan Jinyintan Hospital (Infectious Diseases Hospital), Department of Infection, Chief Physician, Master's Tutor
    .

    Member of the Standing Committee of the AIDS Group of the Professional Committee of Infectious Diseases of the Chinese Medical Doctor Association; member of the Standing Committee of the Professional Committee of HIV and Tuberculosis of the Chinese Association for the Prevention and Treatment of STDs and AIDS; Member of the Standing Committee of the Professional Committee of AIDS and Opportunistic Infections of the Chinese Association for the Prevention and Treatment of STDs and AIDS; the AIDS of the Chinese Society of Tropical and Parasitic Diseases Group member; Standing member of the Liver Disease Professional Committee of Hubei Association of Traditional Chinese Medicine; member of the Liver Disease Professional Committee of Hubei Association of Integrated Traditional Chinese and Western Medicine; member of the Standing Committee of the Wuhan Preventive Medicine Association STD and AIDS Professional Committee; member of the Hubei Provincial AIDS Clinical Expert Group
    .

    Presided over 1 sub-project of the National Key R&D Program and 6 provincial and municipal projects; published more than 30 papers, including 7 SCI papers; won 1 first prize of Hubei Province Science and Technology Progress Award and 1 third prize of Wuhan Science and Technology Progress Award
    .

      HIV PEP is a biomedical intervention that uses antiviral drugs to block HIV transmission after exposure, and is an important part of a comprehensive HIV intervention strategy that helps reduce HIV infection and transmission
    .

    In the implementation of HIV PEP, we should focus on the following points: 1.
    Do a good job in assessment: a.
    HIV exposure time assessment: within 72 hours; b.
    HIV exposure risk assessment: analysis of exposure sources and exposure behaviors
    .

    2.
    Do a good job of testing: HIV antibody test, syphilis test, hepatitis B (HBV) serological test, hepatitis C (HCV) antibody test, urine routine, serum creatinine
    .

    3.
    Do a good job in compliance education: take the medicine for 28 days in a row, and deal with the side effects of the medicine in time
    .

    4.
    Behavioral intervention: PEP cannot prevent other sexually transmitted infections and cannot replace condoms
    .

    5.
    Do a good job in follow-up: The difficulty of PEP work is follow-up, and a case management service model should be established.
    30 days and 90 days after the inquirer is exposed, HIV and HCV antibody detection and follow-up are respectively performed on the drug users
    .

    References: [1] Health Commission: my country's AIDS blood transfusion transmission basically blocks the lowest rate of mother-to-child transmission in history [J].
    Modern Health, 2018(22): 2-3.
    [2] AIDS, Chinese Medical Association Infectious Diseases Branch Chinese Center for Disease Control and Prevention of Hepatitis C Group using this product in a manner that does not match the prescribing information approved in your country,
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