PEP (post-exposure prophylaxis) is an emergency HIV treatment that must be taken as quickly as possible after you’re exposed to HIV in order to reduce the risk of infection.
What is PEP?
PEP is an HIV treatment that lasts 28 days and must be taken in full as prescribed by your doctor. It’s best to start PEP in the two hours following HIV exposure, or at the latest starting 72 hours (three days) afterward. The earlier you begin the treatment, the higher the chance it will prevent the virus from spreading in your body. This way, you can avoid infection.
If you get a PEP prescription, you’ll be subject to medical monitoring during and after the treatment:
- To evaluate and reduce unpleasant side effects from the medication, if any.
- To get tested for HIV in order to determine whether infection has occurred.
The unpleasant side effects may include:
- Nausea and headaches;
These effects usually disappear soon after treatment begins. In any case, your doctor can help you reduce them.
Because PEP is not guaranteed to be effective, using condoms during your treatment can help you avoid transmitting the virus to your partners.
When should you take PEP?
You may want to take PEP if you’re HIV-negative and you’ve been exposed to a high risk of HIV infection, for example if you’ve had anal sex (top or bottom), vaginal sex or frontal sex without a condom, or if the condom broke:
- With an HIV-positive partner whose viral load is high or unknown.
- With a partner whose HIV status is unknown.
Both situations count, regardless of how deep penetration went or how long it lasted.
PEP can also be used after you’ve shared equipment for preparing, injecting or inhaling drugs, whether or not the situation included having sex.
A medical professional will assess the possible risk of HIV infection. If the assessment shows a sufficiently high risk, they can prescribe PEP.
Where can you get access to PEP?
To get access to PEP, go immediately to the hospital emergency room or to a specialized HIV and STBBI clinic, ideally within two hours after having sex with HIV transmission risk. You can call Info-Santé (811) or the HIV organization in your area to find out where to go. PEP can be prescribed by any doctor.
Unfortunately, some health professionals don’t know about this treatment. If you go to the emergency room, you may need to insist in order to get it. If possible, visit a clinic that specializes in HIV and STBBIs.
To find the place closest to you, use the search tool by postal code.
How much does it cost?
The 28-day treatment costs between $1,500 and $2,000.
If you’re covered by the Québec’s public prescription drug plan, PEP will cost your maximum monthly amount, which is around $93 (2019–2020).
If you have group insurance, the amount may vary depending on the insurance policy. Ask your insurance company to find out more.
What happens at the first PEP appointment?
Before prescribing PEP, the medical professional will assess the situation:
- They’ll offer you a rapid HIV test to confirm your HIV status. If the result is positive, PEP won’t be prescribed; instead, you’ll be oriented and supported for an HIV diagnosis.
- They will ask about the HIV status (positive or unknow) of the person you had sex with.
- If the person is HIV-positive, they will try, within the appropriate time frame, to verify the person’s viral load what HIV medication they’re taking, and the list of viral resistances. PEP is not prescribed when the person’s viral load is undetectable (fewer than 200 copies per millilitre of blood).
- They will ask about the time elapsed since your risk exposure. The treatment must take place within 72 hours; ideally it should be within two hours of exposure. Beyond that time frame, PEP won’t be prescribed.
- They will check your risk level. In general, only a high exposure risk requires treatment. High-risk practices include anal or vaginal penetration without a condom, and the sharing of drug injection equipment.