July 28, 2013

July 28, 2013
Am I Infected?
(A Guide to Testing for HIV)
Part 2

Welcome to another day in my life. Today is Sunday and I hope you are having a beary safe and great weekend so far. It is another busy weekend for Dab the AIDS Bear and me.

If you are still HIV negative and are sexually active then you should be going for a HIV test at least every six months. So yesterday I started blogging about the process of getting a HIV test that I will conclude today.

Should I get tested for HIV?

Getting tested is recommended if any of the following apply to you:
You should be tested at least once a year if you are sexually active, particularly with three or more sexual partners in the last 12 months.
You had a possible exposure to HIV either through vaginal or anal intercourse without the use of a condom or have been involved in any other risky sexual behavior.
You have shared/reused needles or syringes to inject drugs (including steroids), or for body piercing, tattooing, or any other reason.
You are a health care worker who's had a work-related accident such as direct exposure to blood or have been stuck with a needle or other object.
You are uncertain about your sexual partner's risk behaviors or your sexual partner has tested positive for HIV.
You are pregnant or are considering becoming pregnant.
You have had certain illnesses including TB (tuberculosis), or an STI (sexually transmitted infection), such as syphilis or herpes.
You have any reason to be uncertain about your HIV status.

If you have engaged in behaviors that have put you at risk of becoming infected with HIV, you may also have been exposed to other STIs. Some of these can be quite serious and require immediate treatment, such as syphilis or hepatitis C virus (HCV). If you are being tested for HIV you should also discuss with your provider whether you are at risk and should be tested for these STIs.

What about PEP and PrEP?

PEP stands for Post-Exposure Prophylaxis. PrEP stands for Pre-Exposure Prophylaxis. Both involve using antiretroviral drugs to prevent HIV infection.

PEP has long been used in hospitals and other "occupational" settings. It involves giving a short course of antiretroviral treatment to someone who may have been exposed to HIV, such as a hospital worker who is accidentally stuck with a sharp instrument or needle that was recently used on someone known to be infected with the virus. In this situation, a 28-day course of HIV treatment—usually a combination of two or three approved antiretrovirals—is started to help prevent the virus from establishing infection in the body.

PEP can also be used in "non-occupational" situations, such as possible exposure to the virus after sexual activity or injection drug use. According to guidelines from the CDC, however, It is only intended for people who have engaged in high-risk activity with someone known to be HIV positive and when the person seeks care within 72 hours of exposure. As with possible occupational exposure to the virus, it is best if PEP is started within hours of a possible non-occupational exposure. It will not likely be effective if started more than 48 to 72 hours after possible exposure.

If you fear that you may have been exposed to HIV and are trying to figure out if PEP is right for you, get in touch with your doctor or a nearby hospital emergency room immediately! PrEP involves having an uninfected person take ARV drugs—usually Truvada (tenofovir plus emtricitabine)—before, during and after possible high-risk exposures to reduce the risk of becoming infected with HIV. Based on the results of clinical trials completed to date, the U.S. Food and Drug Administration (FDA) has approved Truvada as PrEP, with the requirement that it be used every day, even during periods of minimal or low-risk sexual activity. Future studies may explore intermittent dosing strategies (e.g., using PrEP only during periods of high-risk sexual or drug-using activity). Before providers prescribe PrEP, the U.S. Centers for Disease Control and Prevention (CDC) recommend a thorough assessment of a person’s HIV risk behaviors. An HIV test (a more sensitive test to determine a recent infection may be used in those with symptoms) and tests for sexual transmitted infections (STIs) are recommended. So, too, are tests for kidney function—the tenofovir in Truvada is associated with kidney toxicity—and hepatitis B virus (HBV) infection, given that Truvada is also active against HBV and must be used cautiously.

Providers are cautioned to prescribe no more than a 90-day supply of PrEP and to offer extensive HIV risk-reduction counseling, adherence counseling and condoms.

Follow-up is recommended every two to three months to test again for HIV. Further assessments are also recommended at this time for adherence and continued HIV risk behavior, and to provide ongoing support and counseling for these. Kidney function testing is again recommended three months after a person first starts PrEP and yearly thereafter. Tests for common STIs are also recommended every six months, even if a person has no symptoms.

The CDC also recommends that before people discontinue PrEP—whether because of safety concerns, a positive HIV test result, or a person requests to stop treatment—their providers should link them to HIV care (if a person has become infected) or ongoing HIV risk-reduction counseling and support. For people who have HBV, their providers should also discuss whether to continue treatment as a means to control HBV infection.

Common myths about how HIV is spread

These are some of the circumstances you don't have to worry about because they will not put you at risk for becoming infected with HIV:
Being bitten by a mosquito or other bugs, being bitten by an animal.
Eating food handled, prepared or served by somebody who is HIV positive.
Sharing toilets, telephones or clothing.
Sharing forks, spoons, knives, or drinking glasses. Touching, hugging or kissing a person who is HIV positive.
Attending school, church, restaurants, shopping malls or other public places where there are HIV-positive people.
HIV cannot be transmitted though urine, feces, vomit, or sweat. It is present, but only in negligible quantities, in tears and blister fluid. It is present in minute amounts in saliva in a very small number of people.

Tomorrow I will blog about why you need to know your HIV status and other information.

Hope you have a beary safe and great Sunday!

Until we meet again; here's wishing you health, hope, happiness and just enough.

big bear hug,

Daddy Dab