Wed Apr 1 12:32:42 SGT 2015  
STD

SG™
    HIV PEP
STD SG™
Within 3 days after unprotected sex, stop HIV infection with Post-Exposure Prophylaxis treatment
28 days after unprotected sex, accurately detect HIV infection with the 20 minute rapid test
Full & comprehensive sexually transmitted disease testing

HIV PEP | STD SG™

Summary

HIV PEP | STD SG™ @std_sg: HIV (human immunodeficiency virus) PEP (post-exposure prophylaxis) treatment to stop HIV infection within 72 hours of exposure, Singapore. Private & confidential service.

Advertisement: Come to sunny Singapore to have your testing and treatment. Singapore Ministry of Health registered general practice (GP) clinic:
SHIM CLINIC
STD SG™
168 Bedok South Avenue 3 #01-473
Singapore 460168
Tel: (+65) 6446 7446
Fax: (+65) 6449 7446
24hr Answering Tel: (+65) 6333 5550
Web: HIV PEP | STD SG™
Opening Hours
Monday to Friday: 9 am to 3 pm, 7 pm to 11 pm
Saturday & Sunday: 7 pm to 11 pm
Public Holidays: Closed
Last registration: one hour before closing time.
Walk-in clinic. Appointments not required.
Bring NRIC, Work Pass or Passport for registration.

Description

Table of Contents

HIV prevention / HIV PEP (post-exposure prophylaxis) treatment can prevent you from getting an HIV infection, and turning HIV positive.

Individuals are eligible for HIV PEP Treatment if all the following criteria are met:

  1. less than 72 hours has elapsed since exposure;
    and
  2. the exposed individual is not known to be HIV infected;
    and
  3. the person who is the source of exposure is HIV infected or has unknown HIV status;
    and
  4. mucous membrane or non-intact skin was exposed to a potentially infectious body fluid;
Prompt antiviral therapy may reduce the risk of HIV transmission by as much as 80%.

For optimal efficacy, antiretroviral therapy should be started as soon as possible, ideally within 1 hour of exposure. So that you can remain HIV negative.

The medications and dosages are the same as those used for lifelong treatment of HIV patients. However, for HIV PEP treatment, it is taken for only a month.

Algorithm for evaluation and treatment of possible nonoccupational HIV exposures

References

Drugs commonly used in HIV PEP: References HIV Risk (2009 figures)

Estimated HIV transmission risk per exposure for specific activities and events

Activity Risk-per-exposure
Vaginal sex, female-to-male, studies in high-income countries 0.04% (1:2380)
Vaginal sex, male-to-female, studies in high-income countries 0.08% (1:1234)
Vaginal sex, female-to-male, studies in low-income countries 0.38% (1:263)
Vaginal sex, male-to-female, studies in low-income countries 0.30% (1:333)
Vaginal sex, source partner is asymptomatic 0.07% (1:1428)
Vaginal sex, source partner has late-stage disease 0.55% (1:180)
Receptive anal sex amongst gay men, partner unknown status 0.27% (1:370)
Receptive anal sex amongst gay men, partner HIV positive 0.82% (1:123)
Receptive anal sex with condom, gay men, partner unknown status 0.18% (1:555)
Insertive anal sex, gay men, partner unknown status 0.06% (1:1666)
Insertive anal sex with condom, gay men, partner unknown status 0.04% (1:2500)
Receptive fellatio Estimates range from 0.00% to 0.04% (1:2500)
Mother-to-child, mother takes at least two weeks antiretroviral therapy 0.8% (1:125)
Mother-to-child, mother takes combination therapy, viral load below 50 0.1% (1:1000)
Injecting drug use Estimates range from 0.63% (1:158) to 2.4% (1:41)
Needlestick injury, no other risk factors 0.13% (1:769)
Blood transfusion with contaminated blood 92.5% (9:10)

Sources: vaginal sex;1 anal sex;2 fellatio;3 2 mother-to-child;4 other activities.5

References

  1. Boily MC et al. Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies. Lancet Infect Dis 9(2): 118-129, 2009
  2. Vittinghoff E et al. Per-contact risk of human immunodeficiency virus transmission between male sexual partners. American Journal of Epidemiology 150: 306-311, 1999
  3. Del Romero J et al. Evaluating the risk of HIV transmission through unprotected orogenital sex. AIDS 16(9): 1296-1297, 2002
  4. Townsend C et al. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000-2006. AIDS 22: 973-981, 2008
  5. Baggaley RF et al. Risk of HIV-1 transmission for parenteral exposure and blood transfusion. AIDS 20: 805-812, 2006
  6. HIV & AIDS Information :: How transmission occurs - Estimated risk per exposure

HIV Risk (2005 figures)

Estimated per-act risk for acquisition of HIV, by exposure route*

Exposure routeRisk per 10,000
exposures
to an infected source
%
Blood transfusion900090
Needle-sharing injection-drug use670.67
Receptive anal intercourse500.5
Percutaneous needle stick300.3
Receptive penile-vaginal intercourse100.1
Insertive anal intercourse6.50.065
Insertive penile-vaginal intercourse50.05
Receptive oral intercourse†10.01
Insertive oral intercourse†0.50.005
*Estimates of risk for transmission from sexual exposures assume no condom use.
†Source refers to oral intercourse performed on a man.

References

HIV risk (2002 figures)

HIV Risk Statistics (chances of getting HIV)

HIV Risk Factors HIV Transmission Probability
Needle stick injury3 1/300
Receptive anal intercourse4 1/100
Receptive vaginal intercourse5 1/1000
Insertive vaginal intercourse4 1/2000
Insertive anal intercourse4 1/2500
Receptive fellatio with ejaculation4 1/2500
Sharing needles6 1/150

References

  1. Cardo DM, Culver DH, Ciesielski CA, et al. A Case-Control Study of HIV Seroconversion in Health Care Workers after Percutaneous Exposure. N Engl J Med. 1997;337:1485-1490.
  2. Katz MH, Gerberding JL. Management of occupational and nonoccupational postexposure HIV prophylaxis. Current Inf Dis Reports. 2002;4:543-549.
  3. Gerberding JL. Prophylaxis for Occupational Exposure to HIV. Ann Intern Med. 1996;6:497-501
  4. Vitinghoff E, Douglas J, Judon F, et al. Per-Contact Risk of Human Immunodificiency Virus Transmision between Male Sexual Partners. Am J Epidemiol. 1999;150:306-311.
  5. Peterman TA, Stoneburner RL, Allen JR, et al. Risk of Human Immunodeficiency Virus Transmission From Heterosexual Adults With Transfusion-Associated Infections. JAMA. 1988;259:55-58. [Erratum. JAMA. 1989;262:502]
  6. Kaplan EH, Heimer R. A Model-Based Estimate of HIV Infectivity via Needle Sharing. J Acquir Immune Defic Syndr. 1992;5:1116-1118.
HIV is the abbreviation for the human immunodeficiency virus, which causes the acquired immunodeficiency syndrome

HIV symptoms which may present in acute HIV infection:

These are nonspecific symptoms and can present with other infections; consequently, they are unreliable indicators of HIV infection.

Kaposi's sarcoma Remember, there is no HIV cure.

HIV window period is the time from HIV infection until a HIV Test can detect any change. Within the HIV window period, the HIV Test would be negative. During this period, the HIV viral load is extremely high, thus making the person highly infectious.

  • 4 weeks after exposure, a negative 4th generation HIV ELISA Test "is very reassuring / highly likely to exclude HIV infection."
  • 12 weeks after exposure, a negative 3rd generation HIV ELISA Test "would definitively exclude HIV infection."
References HIV Test

Window
period
Test
Notes Sampling Method
Time to Results
Cost / Price
0-72 hours
No test available
2 weeks (as short as 10-12 days)
HIV DNA test
  • A PCR (polymerase chain reaction) NAT (nucleic acid test) for HIV-1 proviral DNA, therefore a HIV DNA Test.
  • Method: Proviral DNA Polymerase Chain Reaction (Roche Amplicor HIV-1 DNA Test, V1.5) This test uses primers SK145 and SKCC1B to define a sequence of 155 nucleotides within a highly conserved region of the HIV-1 gag gene.
  • Usually used for the early diagnosis of HIV infection in neonates born to HIV+ mothers. As maternal antibodies circulate in the child for several months, the HIV antibody test would be positive.
  • Also used for early HIV diagnosis in adults.
Venipuncture
(Monday-Friday
before 10am)
1-2 weeks
SG$876/=
1 month
HIV combo test
Fingerprick
20 minute
HIV rapid test
SG$150/=
1 month
HIV duo test
Venipuncture

1-2 days
SG$48/=
3 months
OraQuick®
HIV oral test /
HIV saliva test /
Fingerprick
20 minute
HIV rapid test
SG$50/=
3 months
HIV blood test
Venipuncture
1-2 days
SG$12/=
HIV
confirmation
HIV western blot test
Venipuncture
1-2 weeks
SG$275/=
HIV
follow-up
HIV RNA test
Venipuncture
(Monday-Friday
before 10am)
1-2 weeks
SG$717/=

HIV ELISA (Enzyme-linked immunosorbent assay) test generations:

  1. 1st generation: HIV-1 IgG antibody
  2. 2nd generation: HIV-1 & HIV-2 IgG antibodies
  3. 3rd generation: HIV-1 & HIV-2 IgG & IgM antibodies
  4. 4th generation: HIV-1 & HIV-2 IgG & IgM antibodies and HIV p24 antigen
References HIV rapid test (20 minutes to results) Two types are available:

Note: If the clinic attendance is only for the HIV rapid test, then consultation fees are not added.

References

HIV PCR (polymerase chain reaction) NAT (nucleic acid test) TORCH

TORCH complex is a medical acronym for a set of perinatal infections (i.e. infections that are passed from a pregnant woman to her fetus), that can lead to severe fetal anomalies or even fetal loss.
Other agents are:

Sexual risk (of HIV/STD/pregnancy), and what you can do before and after exposure.

Timeline HIV STD Pregnancy
Before exposure
Abstain from sex, Be faithful, or Condom use
Circumcision (males only)
Contraception (females only)
HIV PrEP (pre-exposure prophylaxis) STD vaccine:
- Hepatitis vaccine
- HPV vaccine
STD / HIV exposure
Unsafe sex / unprotected sex:
No condom / Condom broke / Condom slip
0-72 hours HIV prevention
HIV PEP (post-exposure prophylaxis) treatment
- Stop HIV infection after exposure.
STD testing.
If STD symptoms appear, then do STD treatment.
- Males: Do not urinate for at least 4 hours before arriving.
- Females: testing is more accurate when you are not menstruating.
Emergency contraception (females only)
2 weeks HIV DNA PCR test
1 month 20 minute HIV rapid test - SD Bioline HIV Ag/Ab Combo:
- Fingerprick blood sampling.
3 months 20 minute HIV rapid test - OraQuick®:
- Oral saliva or
- Fingerprick blood sampling.
Full & comprehensive STD testing
- Males: Do not urinate for at least 4 hours before arriving.
- Females: testing is more accurate when you are not menstruating.

References


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