What is PEP?

PEP (post-exposure prophylaxis) means taking medicine to prevent HIV after a possible exposure.

PEP Must Be Started Within 72 Hours of Possible Exposure to HIV

Talk right away (within 72 hours) to your health care provider, an emergency room doctor, or an urgent care provider about PEP if you think you’ve recently been exposed to HIV:

• during sex (for example, if the condom broke),
• through sharing needles, syringes, or other equipment to inject drugs (for example, cookers), or
• if you’ve been sexually assaulted.

The sooner you start PEP, the better. Every hour counts. If you’re prescribed PEP, you’ll need to take it daily for 28 days.

PEP is for Emergency Situations

• PEP is given after a possible exposure to HIV.
• PEP is not a substitute for regular use of other HIV prevention.
• PEP is not the right choice for people who may be exposed to HIV frequently.
• If you are at ongoing risk for HIV, such as through repeated exposures to HIV, talk to your health care provider about PrEP (pre-exposure prophylaxis).

How well does PEP work?

If taken within 72 hours after possible exposure, PEP is highly effective in preventing HIV. But to be safe, you should take other actions to protect your partners while you are taking PEP. This includes always using condoms with sexual partners and not sharing needles, syringes, or other equipment to inject drugs.

Are there any side effects?

• PEP is safe but may cause side effects like nausea in some people.
• In almost all cases, these side effects can be treated and aren’t life-threatening.

What Is PEP?

HIV PEP, or post-exposure prophylaxis, is a short course of HIV medicines taken very soon after a possible exposure to HIV to prevent the virus from taking hold in your body.

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

PEP should be used only in emergency situations. It is not meant for regular use by people who may be exposed to HIV frequently.

How Do You Know If You Need PEP?

PEP may be right for you if you are HIV-negative or don’t know your HIV status, and you think you may have been exposed to HIV in the last 72 hours:

• During sex (for example, you had a condom break with a partner of unknown HIV status or a partner with HIV who is not virally suppressed)
• Through shared needles, syringes, or other equipment used to inject drugs (for example, cookers)
• Through sexual assault
• Through a possible workplace exposure, such as from needlestick injury. Workplace HIV transmission is extremely rare.

Where Can You Get PEP?

If you think you were recently exposed to HIV, contact a health care provider immediately or go to an emergency room or urgent care clinic right away.

Your health care provider, an urgent care provider, or emergency room doctor will evaluate you, help you decide whether PEP is right for you, and work with you to determine which medicines to take for PEP.

How Long Do You Need to Take PEP?

If you are prescribed PEP, you will need to take the HIV medicines every day for 28 days. It is important to take all the doses as prescribed to give PEP the best chance of working.

You will also need to return to your health care provider at certain times while taking PEP and after you finish taking it for follow-up HIV testing at 4 to 6 weeks and at 3 months and for other lab tests.

How Well Does PEP Work?

PEP is effective in preventing HIV infection when it’s taken correctly, but it’s not 100% effective. The sooner you start PEP after a possible HIV exposure, the better.

While taking PEP, it’s important to use other HIV prevention methods, such as using condoms the right way, every time you have sex and using only new, sterile needles and works when injecting drugs.

Doxy-PEP: Medicine to Prevent Sexually Transmitted Infections (STIs)

There is another form of PEP that is effective at preventing STIs. A research study found that the oral antibiotic doxycycline reduced STIs by two-thirds when tested among men who have sex with men (MSM) and transgender women, including people with HIV, who took the medication within 72 hours of having condomless sex. This prevention approach is called doxy-PEP or STI PEP. However, the research also showed a slight increase in antibacterial resistance. Doxy-PEP does not prevent HIV. Talk to your provider about whether doxy-PEP is right for you to prevent STIs.

Does PEP Cause Side Effects?

PEP is safe, but the HIV medicines used for PEP may cause side effects like nausea in some people. In almost all cases, these side effects can be treated and aren’t life-threatening.

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). For this reason, it’s important to tell your health care provider about any other medicines that you take, including over the counter medications, street drugs, and alcohol.

Can You Take PEP When You Are Pregnant or Breastfeeding?

Yes. PEP is safe during pregnancy and breastfeeding. If you are pregnant or breastfeeding, consult with a health care provider about PEP and which PEP regimen is right for you.

Can You Take PEP Every Time You Have a Potential Exposure to HIV?

No. PEP should be used only in emergency situations. It is not intended to replace regular use of other HIV prevention methods. If you feel that you might be exposed to HIV frequently, talk to your health care professional about PrEP (pre-exposure prophylaxis).

Q: Can you reduce the risk of getting HIV after having unprotected sex with someone who has HIV?

Let's say you had sex with someone who has HIV infection and the condom broke, or you found out only after condomless sex that your partner had HIV. Can you reduce your risk of getting HIV from sex--or from a needlestick--by taking medications afterward?

Yes. This is called postexposure prophylaxis, or PEP.

The medications that are given for PEP are the same types that are used to treat HIV (antiretrovirals, or ARVs), and they usually are given as a combination of 3 medicines for 1 month. To work best, these ARVs should be taken as soon as possible after the exposure, and ideally not later than 72 hours (3 days) after the exposure. To be evaluated for PEP, the exposed individual should contact their clinician or an emergency room promptly after the exposure. If the provider is unsure about whether or how to give PEP, they can call the free 24-hour National Clinicians' Consultation Center (NCCC) PEPline at 888-448-4911. Many emergency rooms and insurance plans will provide the ARVs for PEP.

Exposed persons do not have to know the HIV status of the person with whom they had contact in order to be offered PEP--providers will evaluate the risk level of the exposure and, if possible, offer testing to the source individual. The exposed person should be tested to see if they already (without knowing it) have HIV or other sexually transmitted diseases such as hepatitis B, gonorrhea, chlamydia, and syphilis, but the first dose of PEP should not be delayed in order to complete that testing. The sooner after the exposure PEP medicines are started, the more likely they are to be effective. People on PEP should be monitored for side effects from the PEP medicines and tested again for HIV after the treatment is completed.

If you have a partner who has HIV, or if you have had to take PEP more than once, you might want to consider taking pre-exposure prophylaxis (PrEP). PrEP is an ARV pill that people who are at risk of getting HIV can take every day to prevent HIV infection.

Types of violence against women

The types of violence against women that play a role in HIV infection rates among women include:

• Forced sex. In the United States, nearly one in five women has been raped in her lifetime and two in every five women have experienced another type of sexual assault. Sexual assault puts you at risk for HIV, because the man may not use a condom during sexual violence. Forced sex can also cause tears or cuts that allow easy entry of HIV. This is especially true for girls and younger women, whose reproductive tracts are not fully developed.
• Sexual abuse in childhood (a form of violence against women) raises your lifetime risk of getting HIV. Women who were sexually abused are more likely than women who were not abused to report risk-taking behavior later in life.
• Human trafficking or sex trafficking is linked to the global spread of HIV and new strains of HIV. It raises HIV risk for its victims because they are often:
  • Having forced and unsafe sex with multiple partners
  • Injecting or otherwise using illegal drugs to make or keep them compliant
  • Self-injecting or otherwise using drugs to cope
  • Getting medical and/or surgical treatment by unqualified practitioners in unsanitary conditions. Women may be exposed to contaminated instruments and/or unscreened blood supplies for pregnancy terminations.

Take steps to lower your risk when talking to your partner about HIV.

Women with HIV may be at risk for violence when they tell a partner about their HIV status. Take these steps to lower your risk:

• Find a domestic violence service in your community and ask for help. Call the National Domestic Violence Hotline at 1-800-799-SAFE (7233).
• Tell your partner that you have HIV before you get sexually involved.
• Break the news in a semi-public place. Make sure other people are around in case you need help.

If you feel at all threatened by your partner's reaction, stop seeing him or her. If you must meet, do so only in public.

Should I take PEP if I think I’ve been exposed to HIV at work?

If you think you’ve been exposed to HIV at work, see a health care provider, an emergency room doctor, or an urgent care provider right away.

• Report your exposure to the appropriate person at work and seek medical attention immediately.
• PEP must be started within 72 hours after an exposure. The sooner you start PEP, the better. Every hour counts.
• Careful practice of standard precautions can help reduce the risk of exposure while caring for patients with HIV.
• Learn more about occupational exposure to HIV and how to prevent it.

Occupational HIV transmission is extremely rare.

Only 58 cases of confirmed occupational HIV transmission to health care personnel have been reported in the United States. An additional 150 possible transmissions have also been reported to CDC.^*

How can I prevent occupational HIV transmission?

Follow Standard Precautions at all times. Assume that blood and other body fluids are potentially infectious.

What if an HIV exposure happens at work?

View CDC’s Guidelines for the Management of Occupational Exposures to HIV and
Recommendations for Post-exposure Prophylaxis (PEP).

^* Based on the most recent data available in December 2013. Of these, only 1 confirmed case has been reported since 1999.

How can I pay for PEP?

Depending on the reason you are prescribed PEP, you may qualify for free or low-cost PEP medicines.

Paying for PEP After a Sexual Assault

• You may qualify for partial or total reimbursement for medicines and clinical care costs.

Paying for PEP After an Exposure at Work

• Your workplace health insurance or workers’ compensation will usually pay for PEP.

Paying for PEP for Another Reason

• If you cannot get insurance coverage, your health care provider can apply for free PEP medicines through the medication assistance programs run by the manufacturers.
• These requests for assistance can be handled urgently in many cases to avoid a delay in getting medicine.
• Enrollment applications, such as Gilead’s Advancing Access form or NASTAD’s Patient Assistance tool, can be completed online, over the phone, or by fax.