NZAF Welcomes Funded Emergency Pep Treatment

NZAF Welcomes Funded Emergency Pep Treatment

The announcement by PHARMAC that post-exposure prophylaxis (PEP) will be subsidised for people who have had unprotected anal sex, or shared injecting equipment, with a known HIV positive person, is being greeted with qualified optimism by the New Zealand AIDS Foundation (NZAF). In effect, the announcement means that anyone who has had anal sex where a condom has broken or come off (or had unprotected anal sex), with a person who has confirmed HIV can apply for government subsidised PEP.

PEP is a prescribed course of antiretroviral treatment that can significantly reduce the risk of becoming HIV positive after exposure. Treatment is most effective when started within an hour of exposure to HIV and no longer than 72 hours. PEP treatment usually takes four weeks and, while the cost for the patient will be minimal with the subsidy, the cost to the government is very expensive.

Rachael Le Mesurier, NZAF Executive Director says, “the NZAF lobbied for this decision because accidents can, and do, happen. While people who have been exposed to HIV in the workplace have had access to subsidised PEP for some time, when exposure has occurred outside of a work setting it has been extremely difficult to access. In particular, the number of gay and bisexual men exposed to HIV in serodisconcordant relationships (where one partner is living with HIV and one is not) is likely to be higher than the number of workplace injuries that expose people to HIV, so this is a pragmatic decision for emergencies like a broken condom”.

However, scientific evidence does not support PEP being used as an alternative to tried and true methods of HIV prevention like using condoms and lube for sex. Le Mesurier says, “there is some data that suggests PEP will work, but there have also been cases where it has failed. The efficacy of PEP varies depending on issues such as the delay between exposure and treatment and the viral load of the person who has HIV at the time of exposure.”

Other concerns about PEP include the strict compliance to a treatment regime that is required for PEP to work and unpleasant side effects including diarrhoea, headaches, nausea, vomiting and fatigue. There is also a risk of false negatives in subsequent HIV tests because the PEP can slow the development of the antibodies that produce a diagnosis. Le Mesurier says “anyone taking PEP is unable to be certain about whether it has been effective or not until they have a second HIV test at the six month mark, as well as the standard three month test. Side effects are common and can be horrid which, compounded with six months of uncertainty and stress while waiting to see if the PEP has worked, mean that PEP is in no way an easy option. PEP is a necessary alternative in an emergency. We welcome this announcement but encourage people not to have to take PEP at all by using condoms and lube every time they have sex.”

To apply for PEP either partner should consult their GP or HIV specialist as soon as possible The PHARMAC announcement does not provide subsidised PEP in the event of exposure to HIV through vaginal sex or where HIV status is unknown.

ENDS

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