PEP – prophylaxis after a possible HIV exposure

PEP (post-exposure prophylaxis) is a course of antiretroviral medicines that starts after an exposure during which HIV transmission was possible. Its aim is to prevent the virus from establishing itself in the body.

PEP is not a vaccine and it is not a treatment for an existing HIV infection. It does not protect against other sexually transmitted infections.

Not every exposure carries a risk of HIV, and PEP is not needed in every situation. The decision is made after an individual assessment by a doctor.

A doctor may discuss PEP with you, for example, when:

• there was sex without a condom with a partner who has HIV and is not on effective treatment, or whose HIV status is unknown;
• the condom broke or slipped off;
• needles or syringes were shared;
• a fluid that may contain HIV came into contact with a mucous membrane or broken skin.

The type of exposure, the time that has passed, the body fluid involved, what is known about the partner and the protection used all matter.

When a partner with HIV is on treatment and maintains an undetectable viral load, HIV is not transmitted sexually (U=U). A partner having HIV does not by itself mean that PEP is needed.

PEP works best when it starts early. 72 hours is the maximum time limit for starting it, not the recommended moment for a consultation. When PEP is medically indicated, it should start as early as possible.

The 72-hour limit is not a guarantee of effectiveness. Starting early, completing the full course and follow-up testing are equally important.

If more than 72 hours have passed, a consultation is still useful – for a testing plan and for future protection. Standard PEP is usually not prescribed in that case.

The need for PEP is determined after an individual medical assessment. It helps to share:

• when the exposure happened – the exact or approximate date and time;
• what kind of exposure it was and what protection was used;
• whether you take PrEP and whether any doses were missed;
• the partner's HIV status and viral load, if known to you;
• which medicines you take, any allergies, kidney or liver conditions and whether pregnancy is possible.

If you take PrEP regularly, additional PEP may not be necessary – this depends on the medicine, the regimen and the most recent doses. Do not change your regimen on your own.

You do not need to wait for an HIV test result before seeking a consultation: a baseline test cannot reflect an exposure that has only just happened.

If PEP is indicated, the first dose is not delayed while test results are pending. At the start, an HIV test, kidney and liver function tests, tests for hepatitis and other infections depending on the exposure, and a pregnancy test when needed are usually performed.

The standard course lasts 28 days. The doctor chooses the specific medicines according to your health and any other medication you take. It is important to complete the course, even if you feel well or an early test is negative.

If you miss a dose, vomit or experience side effects, follow the written instructions for your regimen and contact the doctor. Do not double a dose on your own and do not stop taking the medicines without consulting a doctor.

Follow-up is part of the prophylaxis. Follow-up HIV tests are recommended at around 4–6 weeks and around 12 weeks after the exposure; the doctor adapts the plan to the available tests and the local protocol. PrEP and PEP can delay the detection of HIV, so an early negative result does not end follow-up.

During and after the course, use a condom or another barrier and do not share needles. If you expect further situations in which HIV transmission is possible, discuss moving to PrEP after the course with your doctor.

A consultation about whether PEP is needed can take place online with an infectious disease specialist through the external Healee platform (see below).

A consultation about whether PEP is needed can take place online with Dr Ivaylo Pakov, infectious disease specialist, through the Healee platform.

Healee is an external platform, independent of CheckPoint Sofia, which provides its services under its own terms and price list.

Whether a consultation can take place depends on Dr Pakov's commitments and working schedule, as well as on the available appointment times and the terms of the Healee platform.

Where applicable, a prescription and an outpatient record are issued in accordance with current Bulgarian legislation and the conditions for providing medical services remotely.

Consultations through Healee are provided under the terms and the current price list of the external platform. CheckPoint Sofia does not set these terms and does not accept payments for them.

Available times are determined by what is actually published on Healee and by Dr Pakov's working schedule. CheckPoint Sofia does not guarantee a specific appointment, an immediate reply or an immediate consultation.

Planned PrEP consultations are booked separately, through CheckPoint Sofia's booking system, and have their own terms.

Prescribing PEP and issuing a prescription or an outpatient record depend on the doctor's medical judgement, on the type and conditions of the remote consultation and on the applicable legal requirements.

Where applicable, a prescription and an outpatient record are issued in accordance with current Bulgarian legislation and the conditions for providing medical services remotely.

An online consultation does not guarantee that a prescription will be issued or that the medicines will be supplied. CheckPoint Sofia is not responsible for the availability of the medicines in pharmacies or for the opening hours of the pharmacies that dispense the medicines for PEP.