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How Does PrEP and PEP Work In The Body?

How Does PrEP and PEP Work In The Body

The life expectancy of people infected with HIV had jumped from 39 years to about 78 years, thanks to the discovery of highly active antiretroviral therapies (ART). Despite the huge impact of ART in suppressing viral replication to undetectable levels, newly diagnosed HIV infection cases amount to over 40,000/year in the United States alone. It only shows that while preventative approaches in disease management proved to be helpful, they still have a long way to go. Pre-exposure prophylaxis (PrEP) and post exposure prophylaxis (PEP) both work to prevent being infected by the virus, but they are not interchangeable. PrEP meds must be taken in anticipation of an HIV exposure, while PEP is prescribed when a patient has been exposed to the virus, provided it occurs within 72 hours. Beyond that, the antiretroviral medications for PEP may not be effective anymore.

Condom use is the most popular preventive method for sexually-transmitted diseases, but there are other ways to reduce your risk of getting HIV.

  • Abstinence
  • Limiting sexual partners
  • Avoiding drugs and alcohol
  • Being informed about the dangers of HIV and how to prevent them
  • Asking your healthcare provider if you are eligible for PrEP or PEP
  • Wearing routine protective barriers (gloves, masks, and goggles) when dealing with people’s blood and other blood-contaminated items.

Understanding HIV and AIDS

Lack of awareness is one of the contibuting factors in the spread of HIV. In a 2015 study, it has been found that many male labor migrants in China have deficient knowledge about HIV prevention and transmission routes. Up to 40% of migrants did not know that condom can decrease the risk of infection. In other parts of the world, most people know what HIV is but not everyone knows that antiretroviral medications exist.

For people to understand how HIV prophylaxis methods work, they must first understand how the virus infects and replicates in the human body. Human immunodeficiency virus is incurable and eventually progresses into AIDS. Within three months of exposure, the virus can be detected in the blood, but it may take up to six months in some people. Using blood or saliva, the enzyme immunoassay or ELISA test is done to detect HIV. Because the test is not 100% accurate, positive results must be confirmed using a highly sensitive Western blot test or immunoflourescence assay.

What happens when HIV enters your bloodstream?

There are different types of cells that guard the immune system against pathogens. Among these, the most essential guard cells are T- and B-cells. These are special white blood cells (WBC) that work synergistically to fight germs and infection. B-cells produce specific proteins called antibodies, which then try to neutralize invading germs. When a person recovers from infection, these antibodies stay in the blood acting as some sort of “memory” to prevent reinfection. Another specialized group of WBC, the T-helper cells, activates B- and T-cells to fight infection. In the case of HIV infection, activation doesn’t occur. The virus invades T-helper cells and eventually kills them. Overtime, HIV severely weakens your immune system that even simple and easily-treatable infections can have life-threatening effects.

Truvada (emtricitabine and tenofovir disoproxil fumarate) is the drug of choice for pre- and post exposure prophylaxis. The only difference is the duration of treatment and the addition of raltegravir or Isentress for PEP. These drugs work directly protecting T-helper cells, thereby blocking HIV’s ability to replicate. Instead of propagating in immune cells, the virus is contained and destroyed before it causes an infection. People eligible for on-demand PEP regimen may be offered a “starter kit,” which contains:

  • PEP medications for the first three days of treatment;
  • Guidelines for the attending physician and the patient;
  • Consent form.

Patients who were given a starter kit must then arrange a follow up at their prescriber’s office/clinic before starter pack runs out. They can also secure a prescription for the full 28-day course of treatment.




Recommended Regimen


Recommended Regimen

Up to 90 days

Truvada® (tenofovir/emtricitabine) one tablet daily

28 days

Truvada® (tenofovir/emtricitabine) one tablet daily + Isentress (raltegravir) 400 mg twice daily

Initially, PEP was only available for occupational exposures, such as needlestick injury. When activists demanded for making PEP available for non-occupational exposure, including unprotected sex, the Centers for Disease Control and Prevention (CDC) made PEP a standard of care for everyone in 2005. On the other hand, the World Health Organization officially recommended PrEP for men who have sex with men (MSM) in 2014. But upon further assessment of effectiveness and acceptability, PrEP is now the preferred HIV preventive method for anyone at substantial risk of HIV infection.

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