Nearly every day here I see a person who is super anxious and has put their life on hold for anywhere from a month to three months in fear that they have contracted HIV from a momentary lapse of judgement. You can lose sleep, your appetite, your hair can fall, you can be visibly emaciated as well with this amount of stress in life on a daily basis for such a long period.
When it comes to staying safe against HIV in a lifestyle where one is exposed to the virus, it is crucial that one adopts multiple precautionary measures against transmission of HIV.
Apart from choosing partners wisely (we always encourage STI testing prior to being sexually active with someone) and using condoms, there is an additional safety precaution when it comes to safeguarding yourself against HIV transmission.
So in this article, let’s talk about the HIV medication you can take to help protect yourself against HIV. Basically, this is a lifestyle choice that you’d have to make based on as much information as possible. Let’s go over some of the details right.

First off, what is HIV and why are we so worried about it?

Would you like to hear the scary part first? Basically, after decades of studying the virus, we still do not have a cure for it. Now, that doesn’t mean everyone with HIV will die of HIV complications but more that if you do pick up HIV sometime in your life, chances are you’ll die with the HIV still in you. How’s that for a daily nightmare?

HIV Infection

HIV stands for Human Immunodeficiency Virus. HIV is a virus spread through certain body fluids that attacks the body’s immune system, specifically the CD4 cells, often called T cells. Now, once the virus starts infecting the cells, it goes on a continuous rampage of self-replication and destruction. Basically the more of the virus that is present, the worse of an infection it can create. Over time, HIV can destroy so many of these cells that the body can’t fight off infections and disease. Untreated, HIV reduces the number of CD4 cells (T cells) in the body. This damage to the immune system makes it harder and harder for the body to fight off infections.
So imagine your body is fighting a losing battle with HIV, other bacteria, virus and fungi know that your body is already weakened and they do attack the body at that time. These are called opportunistic infections.
So in combination of HIV and opportunistic infections (see: 10 Common HIV Opportunistic Infections), the body gets worn down over time until it succumbs to these infections.

What is AIDS (Acquired Immuno-Deficiency Syndrome)?

AIDS is the most severe phase of HIV infection; basically, it’s the bigger, older, more aggressive older brother that will stop at nothing until your organs cease to function as intended.

HIV mode of transmission

Only certain body fluids—blood, ejaculate or pre-ejaculate material, rectal fluids, vaginal fluids, and breast milk—from a person who has HIV can transmit HIV. Bear in mind that a simple contact or a touch gesture does not guarantee transmission of the virus. These fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the bloodstream (from a needle or syringe) for transmission to occur.

How Would I Know if I Picked Up the Virus?

Acute Retroviral Syndrome (ARS) – Initial HIV symptoms
There are a few stages to an HIV infection. The very first few symptoms can occur within five to 12 days of exposure to the virus. This is the ARS (Acute Retroviral Syndrome) phase. Now this stage is particularly challenging to diagnose because more often that now, you wouldn’t even go through this phase.
In the off chance that you do have ARS, the symptoms can be so vague and misleading that it may be discarded as something completely different if you do not provide a history of a situation where you might have picked up HIV.
If at any time after a potential exposure episode you happen to develop features as listed below, it would be wise to seek medical attention as soon as you can.

1. Fever – This is usually a high-grade temperature (>38.5) accompanied with chills, tremors, and the occasional night sweats
2. Rash – Look out for an upper chest angry rash that is reminiscent of a chicken pox rash. Think red, fast growing, vesicular like rashes that can be painful or uncomfortably itchy in general.
3. Muscle aches – That feeling that your body is heavy and you just don’t want to get out of bed.
4. A sore throat
5. Swollen lymph nodes – Look out for any abnormal swelling around your neck, behind your neck and under your armpits especially
6. Mouth ulcers

So ideally these HIV symptoms will all come in about the same time with a recent history of potential exposure. This can prompt your physician towards a diagnosis of HIV ARS.
It’s also important to recognise which stage the virus is in so we can expect certain infections and treatment with the aim of covering as wide a net as possible when dealing with HIV.

That being said, we’re here to emphasize protecting yourself against HIV instead of being vulnerable to it and its effects on life in general. As I earlier mentioned, nearly every day we see people who lose weeks worth of sleep being so anxiously paranoid that they might have picked up HIV.
The ideal would definitely be the prevention of HIV transmission to begin with.

We’ll start with Pre-Exposure Prophylaxis (PrEP)

This is where the modernisation of medicine plays a huge part in society. The idea of Pre-exposure prophylaxis or PrEP is that it works similar to how a vaccine would in terms of offering protection against a disease.
The premise is simple. You take a tablet once a day and if taken correctly; combined with safe sexual practices, and there are no other complications, there is an up to 99% chance you will not get HIV if ever exposed to the virus.
HIV PrEP is basically using anti-retroviral medication (basically HIV medications) to prevent the acquisition of HIV infection by an uninfected person. PrEP is offered here in the form of a combination tablet containing tenofovir and emtricitabine (both medications we use to treat HIV).

Descovy As New HIV Medication For HIV PrEP

Descovy (brand name) is a FDA approved new drug combination of tenofovir alafenamide (TAF) + emtricitabine for use as HIV PrEP, which has shown to be equally effective in preventing HIV infection whilst touting an improved safety profile for renal and bone toxicity.

Descovy is currently available in all Singapore DTAP clinics only. It is a prescription-only medication and must be prescribed by a doctor. Speak to our doctors for more information about Descovy and find out if a HIV-1 treatment that contains Descovy is right for you.

Can Anyone Take HIV PrEP?

HIV PrEP was initially created for people who are in the high risk group for contracting HIV. This included people whose spouses were HIV positive. Trying to have a healthy relationship is trying enough as it is. HIV PrEP allows for intercouse with a significant less amount of stress and worries about contracting HIV.
Among other people who are in this high risk group include people who:

• are sexually active in the last 6 months and NOT in a sexually monogamous relationship with a recently tested HIV-negative partner, and who
  • is a man who has sex with men, and who… (see: STD risk from unprotected Anal Sex in Men)
    • engage in anal sex
    • has had a sexually transmitted infection in the past 6 months
  • or is a sexually active adult (male or female with male or female partners), and who…
    • is bisexual (riskier if you have a very active sex life with multiple partners at the same time)
    • has sex with partners at increased risk of having HIV (e.g. injection drug users, men who have sex with men) without consistent condom use.

As we have evolved into prescribing PrEP, we realised that the level of protection it offers should not be confined to a certain group of people but to anyone who is wanting that added layer of protection against HIV transmission.
So really, all you have to do is to speak to your doctor, undergo a few simple tests to ascertain that you are healthy and have had no exposure to HIV prior to that before starting PrEP.
When you first start PrEP you may experience side effects like:

• nausea
• dizziness
• headaches
• fatigue
• stomach cramps

More serious side effects include:

• kidney problems, including failure
• Liver problems
• Reduced bone density

This is why, when on PrEP, it is important to regularly monitor the health of the organs that can be affected by this medication. We’ll have to get regular blood and urine screening is done with regular HIV testing and also bone scans if necessary in some cases. It is always best to continue on these medications with the advice of a physician.
Both our Robertson Walk (Singapore) & KL Eco City (Malaysia, Kuala Lumpur) provide Anonymous HIV Testing if you wish to keep your HIV status anonymous.

Frequently Asked Questions of HIV PrEP

1. Can I get STD even if I am on PrEP?

Yes, of course. HIV is just one type of a STI. There are other STI that aren’t even viruses but are bacteria. In these situations, taking PrEP is irrelevant to the situation. PrEP is designed to protect you against specifically HIV, not all STIs.

2. Do I still need condom even if I am on PrEP

Safe sex practices are always encouraged regardless if you are on PrEP or not. Basically, it is better to be safer really. Using a condom adds another barrier of safety in terms of picking up an HIV infection so really, why compromise on that?

3. Do I need regular HIV testing?

This is indeed encouraged. Its best to go for regular routine check-ups & HIV Testing and discuss your lifestyle and potential risk encounters with your physician to clarify any doubts. We’d also need to confirm that you are not already exposed to the virus before or during your time on PrEP.

4. When can I stop PrEP?

Basically, you can determine that. At any time when you see your lifestyle as not posing a risk of you contracting HIV, you may decide to stop taking the medication. There is no hard and fast rule to this. You can be taking the medications for months or decades if you choose to do so.
Either way, it is imperative that you are safe and in good health whilst taking the medication.

5. Do I have to take it on a daily basis?

Taking PrEP on a daily basis is recommended. This is to ensure compliance to the medication and to allow it to build some sort of protection against the virus. However, if your lifestyle does not call for it, you can choose to do event-based dosing where you take a total of four tablets spaced out over four days before and after a risky encounter.
Obviously, this is less stable a method of acquiring protection against HIV but it is an alternative to people who choose not to take medications on a daily basis ie people who have sexual encounters infrequently.

 Here’s a video on Event Based Dosing for HIV PrEP

Now what is HIV Post-Exposure Prophylaxis (PEP)

So now that we have covered PrEP, let’s move on to PEP (Post Exposure Prophylaxis). This is again a very similar ideology to PrEP where we aim to provide as much protection against transmission of HIV to you. Where it differs is that pre-exposure means before an incident that potentially made you vulnerable to HIV whereas post exposure is the period immediately after you have been potentially exposed to the virus.
Early on in this article, I recounted my experiences dealing with very anxious clients who have lost a weeks worth of sleep because they had to wait out the window period to test for HIV (this is at the least ten days).
This is where PEP comes into play. If for whatever reason you feel that you have been exposed to HIV, come in, see your doctor and get PEP prescribed to you within 72 hours of that and if taken correctly, there is an up to 99% chance you will not get infected with HIV.
See the difference? Immediate action within 72 hours after an HIV potential exposure episode can save you weeks worth of anxiety.
So let’s recap what some potentially dangerous incidences are, shall we? If you are in a position where:-

1. you think you may have been exposed to HIV during sex (for example, if the condom broke), or if you are unsure about your partner’s status
2. there was an abnormal exchange of body fluids – exposed to blood during intercourse or you noticed open cuts and active bleeding from your partner
3. shared needles and works to prepare drugs (for example, cotton, cooks, waiter, medical personnel), or
4. were sexually assaulted

All of the above are just some examples of a risky contact situation which can potentially transmit HIV to you and these are situations where if you have not already been on PrEP, it is advised to get PEP to safeguard against HIV infections.

How do I take PEP?

HIV PEP is a combination of three drugs likely given to you in two tablets. This is similar to PrEP but with the addition of another agent to the regime. Like aforementioned, time is of the essence when it comes to PEP so be quick to get to it and start taking it well within the 72 hours golden period for the best results.
The medications should be taken once or twice daily for a minimum of 28 days consecutively. Keep in mind that this is crucial. Missing out on one dose or even worse, one day’s worth of PEP is definitely not advisable. (HIV PEP is available in all our clinic in Singapore and Malaysia)

How does PEP work?

Essentially, PEP will prevent the replication of HIV in the body. When it cannot replicate, it cannot create a strong enough infection to overwhelm the body’s immune system. Ideally, that will result in the virus eventually dying off because it is unable to further survive in the body with its presence there being insignificant.

How would I know if PEP worked?

As with any medication, we will have to do pre and post therapy testing. Prior to starting PEP, it is ideally advised to get HIV testing done to make sure you have not already been exposed to HIV. Once you have started the medication, try and take them at the same time everyday for at least 28 consecutive days then we’ll have to get you tested within the next two months.
If throughout that time you appear to be well and there is no evidence of HIV picked up in your tests, we can clear you from that particular incident.

Side effects of PEP?

Because the medication regime is somewhat similar to PrEP, you can expect a similar range of side effects but this may be amplified somewhat. Apart from that, it is fairly undramatic.

Can HIV PEP fail?

Yes, unfortunately, there have been reported cases of PEP failure. This means that even with taking medications, the client still got a HIV infection. This is not common and is usually linked to poor compliance or a pre-existing medical condition that may impair the way PEP works.

All in All

To summarise, there are ways to protect yourself from potentially deadly viruses like HIV. You have to be in the know and be responsible for your own health in terms of how you choose to live your life and how to best be safe in it.
As a physician, I am glad to help you out in every step of the way in getting you as safely healthy as possible while allowing you to lead the life you feel will make you happiest and to achieve your full potential.
It is certainly debilitating to catch a virus like HIV when you’re just out doing what you do. It can throw a spanner into your life goals and bring life as you know it into a screeching halt.
Having said that, I hope this article has given you at least a rudimentary idea of how to keep yourself protected and to stay safe. Remember, prevention is always better than cure.
Take care.
This Article is Written By Dr. Kaarthig Ganesamoorthy from Our KL EcoCity Branch in Kuala Lumpur.

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Other Reads:

1. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?

2. What are the Causes of Abnormal Penile Discharge?

3. HPV Infection & HPV Vaccination for Men who have sex with Men

4. STD Risk for Receptive Unprotected Anal Sex in Men

5. Low HIV Risk Doesn’t Mean No HIV Risk

6. HIV PrEP for Travel – How You Need to Know

7. An Overview on STD from an STD Doctor

8. Everything You Need to Know about Herpes Simplex Virus

9. How Do I Treat Oral Herpes (Cold Sores)

10. Syphilis Symptoms – Painless Sore & Ulcers

11. HIV Symptoms – What You Need to Know

12. 10 Common HIV related Opportunistic Infections

13. The HIV Pro-Viral DNA Test can be done 10 days post exposure.

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