Worried You May Have Contracted HIV — What Is PEP, the Emergency HIV Prevention Medication?
We have been receiving more and more inquiries from people who became afraid of HIV after sexual activity, whose condom broke partway through, or who sustained a needlestick injury.
If you are worried about HIV/AIDS, there are ways to get tested and to protect yourself. There is also PEP (pronounced “pep”), a method that reduces HIV infection to as close to 0 as possible when you start taking it within 72 hours of a risk event.
This article gives a clear overview of HIV/AIDS symptoms, testing and prevention — particularly PEP, the emergency HIV prevention medication.
What is included:
– Generic medication, 30 tablets (2 tablets are spares)
– HIV test (same-day)
– Hepatitis B test (same-day)
– Syphilis test (by email)
– Renal function test (by email)
For those taking PEP, we provide, as a package, mental health support along with any additional testing required by the circumstances of the possible infection event, from the risk event until a negative HIV result is confirmed (no additional charge applies).
For those living far away, we offer online consultation and delivery of PEP.
Please feel free to consult us even outside regular consultation hours. For details, please see the link below.
– There is no way to know whether you have HIV without being tested.
– The probability of infection is not high, but there are cases where people do not get tested for HIV and early detection is delayed.
– Within 72 hours of a risk event, there is an emergency HIV prevention medication (PEP, pronounced “pep”) that can prevent HIV infection with over 99% effectiveness.
– We can prescribe generic PEP at about 1/4 the price of the conventional brand-name PEP, and follow-up blood testing and other services are included as a package.
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Note that the prices indicated in this page are all inclusive of tax.
The Difference Between HIV Infection and AIDS
First, let us briefly understand the difference between HIV infection and AIDS.
HIV stands for Human Immunodeficiency Virus.
It is a disease in which you are infected with the HIV virus and the immune strength in your body gradually declines.
Over many years, the HIV virus destroys the immune cells in your body, and eventually you become susceptible even to pathogens that do not normally cause infection, and any illness becomes difficult to cure.
In time, the decline in immune strength becomes severe and AIDS develops.
As a result of the HIV virus destroying immune cells, various illnesses develop.
This disease state is called AIDS (Acquired Immuno-Deficiency Syndrome).
23 representative conditions have been designated, and AIDS is diagnosed at the point when any of these develops.
Epidemiology of HIV and AIDS
In 2021, the number of newly reported cases in Japan was 742 for people with HIV infection and 315 for AIDS patients.
The annual number of newly reported cases of both HIV infection and AIDS has been on a downward trend in recent years. However, the number of tests conducted at public health centers and similar facilities fell in 2020 to less than half of the previous year, and declined further in 2021 compared with the previous year.
Caution is needed, as asymptomatic people with infection may not be adequately diagnosed due to factors such as reduced opportunities for testing accompanying the spread of COVID.
How High Is the Probability of HIV Infection?
The probability of HIV infection is not high. However, because the number of tests has been declining in recent years, the number of people who are HIV positive without being aware of it may be higher than before.
In addition, caution is needed because the number of new patients whose HIV infection has progressed and who present with “sudden AIDS” increased slightly in 2020, even compared with the substantial decline in the number of tests.
Based on data from past papers and other sources, approximate probabilities of HIV infection are shown below. The probability of infection also varies depending on the type of sexual intercourse and whether one is the insertive or receptive partner.
Needlestick: 0.3%
Anal intercourse (receptive partner): 1.38%
Anal intercourse (insertive partner): 0.11%
Vaginal intercourse (female partner): 0.08%
Vaginal intercourse (male partner): 0.04%
Oral sex: virtually no risk of infection
Biting: no data in papers or other sources
How Can You Find Out Whether You Have HIV?
You cannot judge from appearance or symptoms whether your partner has HIV.
The only way to know whether you have HIV is to “get tested.”
We perform HIV-related testing both as rapid tests and as standard tests.
Price: 6,000 JPY
When testing is possible: from 4 weeks after a possible infection event
Test method: blood draw
Test results: after 30 minutes (explained at the clinic)
Note: if the result is positive, an additional blood draw is required for a definitive diagnosis.
Price: 4,500 JPY
When testing is possible: from 4 weeks after a possible infection event
Test method: blood draw
Test results: after 1 to 2 business days (checked by email)
With both rapid testing and standard testing, taking the test together with tests for syphilis or hepatitis B lets you test at a better value.
What Is PEP, the Emergency HIV Prevention Medication?
PEP (pronounced “pep”) is short for Post Exposure Prophylaxis, an oral medication that allows infection to be prevented by taking it even after exposure to HIV.
It refers to a preventive measure in which you begin taking PEP (anti-HIV medication: medication used to treat HIV) within 72 hours after an act that may have transmitted HIV (after exposure), lowering the risk of contracting HIV to almost zero. The medication is taken once a day and continued for 28 days.
People who have had sexual contact with someone who has HIV or someone at high risk of HIV, or a medical accident (needlestick, etc.), and who are within 72 hours of the infection risk
For example,
– You had sex without a condom
– The condom came off during sex
– You had sex with unspecified multiple partners
– The person you had sexual activity with had HIV
– You were the victim of sexual assault
– You are a healthcare worker and had a needlestick accident
You are not eligible if the other person is known to be HIV negative, or if you already have HIV.
We also do not treat people who test positive on the same-day hepatitis B test as eligible. (Because hepatitis B may worsen.)
The Preventive Effect and Side Effects of PEP
If you begin taking it within 72 hours after sexual activity and take it properly, the prevention rate is said to be over 99%.
For about the past 15 years, PEP has been used in Japan when healthcare workers have had needlestick accidents during HIV care and similar incidents; since PEP came into widespread use, no cases of HIV infection through occupational exposure have been observed, and no failures have been reported.
As side effects of PEP, side effects such as nausea and diarrhea can occur with a probability of a few %.
How Much Is PEP?
By using generic PEP, we have made arrangements so that PEP can be introduced inexpensively and safely.
Brand-name PEP prices around 10,000 JPY per 1 tablet, which is extremely expensive (at clinics that handle the brand-name product, around 300,000 JPY including the initial consultation fee and testing prices).
We have introduced generic PEP, and blood draws on the day and 1 month later are included as a package, so you can receive subsequent follow-up at the same time for about 1/4 the price of the brand-name product.
[Total Price] = [consultation fee] + [package price] + [option price]
– Consultation fee: 2,500 JPY for a first visit, 1,000 JPY for a follow-up visit
– A doctor’s consultation is always required in order to be prescribed PEP.
What is included:
– Generic medication, 30 tablets (2 tablets are spares)
– HIV test (same-day)
– Hepatitis B test (same-day)
– Syphilis test (by email)
– Renal function test (by email)
At the start of taking PEP and after taking it, testing for other STIs such as syphilis, gonorrhea and chlamydia can be performed at a special price.
Only for those who purchase the PEP package, we provide the tests below at a special price for 1 month from the PEP purchase.
Gonorrhea and chlamydia (3 sites: genital, throat and anal): 3,000 JPY (normally 19,000 JPY)
Vaginal discharge test (vaginal candidiasis, trichomonas, bacterial vaginitis): 3,000 JPY (normally 4,000 JPY)
The PEP-only options are valid only for 1 month after the PEP purchase.
If you would like to use Doxy-PEP in addition to PEP, adding the “gonorrhea and chlamydia (3 sites: genital, throat and anal)” test (3,000 JPY) allows Doxy-PEP to be prescribed on the same day.
We have everyone who starts (or continues) Doxy-PEP undergo testing for gonorrhea, chlamydia and syphilis at a special price.
[Price of Doxy-PEP medication]
| Quantity | Price (JPY) |
|---|---|
| 2 tablets (1 dose) | 900 |
| 10 tablets (5 doses) | 4,000 |
When starting or continuing Doxy-PEP, be sure to undergo appropriate testing. Prescriptions from facilities that do not perform the relevant tests, or personal imports without testing, carry a risk of drug resistance and are dangerous.
Follow-up testing 1 month after taking PEP can be performed at a special price, as follows.
HIV, hepatitis B and renal function tests: 3,000 JPY
HIV, hepatitis B, syphilis and renal function tests: 5,000 JPY
Prescribing PEP and the Process
Prescribing PEP takes approximately 1 hour in total, from arrival at the clinic through payment.
Visit Within 72 Hours of the Risk Event
You may come without an appointment. Please tell the reception desk that you would like PEP (pronounced “pep”).
Medical Interview and Consultation by a Doctor
The doctor determines whether PEP is indicated.
Testing
A blood test is performed to confirm that you do not have HIV and that there is no problem with taking anti-HIV medication (approximately 20-30 minutes).
Explanation by the Doctor and Signing of the Consent Form
You will receive an explanation from the doctor regarding the off-insurance use of anti-HIV medication and will sign a consent document.
Prescription of PEP
The medication will be handed to you at the reception desk at the time of payment, so please begin taking it.
Follow-Up
Follow-up testing (HIV, syphilis, hepatitis B) is performed 1 month after you start taking it (the price is included in the PEP package). After that, we recommend that you undergo HIV and hepatitis B testing as appropriate at 3 months and 6 months (at additional price).
For highly urgent PEP prescriptions — such as when more than 72 hours have passed since exposure, which regular consultations cannot accommodate — please inquire via our Official LINE.
Q&A About PEP
Frequently asked questions about PEP are summarized below.
What is the difference between PEP and PrEP?
With PEP you take medication "after" sexual intercourse that may transmit HIV, while with PrEP you take it continuously "before" sexual intercourse, thereby preventing HIV. If you would like a PrEP prescription, please see here.
How effective is treatment with PEP?
Since PEP became available, there has not been a single case of infection in developed countries since 2000 from needlestick accidents among healthcare workers (accidents in which a needle used on a person with HIV is accidentally stuck into oneself), which carry a higher risk than sex.
By starting PEP as early as possible, HIV can be prevented with a high probability.
I am unsure whether to take PEP. Do I need it?
If you have had, or may have had, contact with the bodily fluids of a person with HIV (semen, vaginal secretions, blood, etc.), you should consider taking it, but please consult with a doctor about the specific decision.
What is the difference between generic and brand-name products?
A generic is a medication released after the patent on the brand-name product expires, and is equivalent to the brand-name product in active ingredients, quality, efficacy and safety.
The brand-name PEP product is extremely expensive at around 10,000 JPY per 1 tablet, so we use generics in order to provide it to patients inexpensively.
Why is it cheaper than at other clinics?
We keep prices down by using generic medication.
Also, out of a desire to see HIV prevention medication become widespread in Japan as well, we provide it as inexpensively as possible.
May I crush the tablet before taking it?
If you take it crushed, it will taste bitter. In addition, there are no data examining absorption and similar factors when the tablet is crushed, so we cannot recommend it.
Is there a set time to take the medication?
It must be taken within 72 hours (3 days) of the occasion on which infection may have occurred, and the sooner the better for preventive effect. There is no particular specified time of day.
Are there side effects?
Nausea, insomnia, irritability, dizziness and the like have been reported.
In most cases these are mild, but if you have any concerns, please consult with a doctor.
I forgot to take my morning dose. What should I do?
If you notice that you have missed a dose, take 1 dose immediately when you notice. However, if the next regular dosing time is near (as a guide, within 12 hours), do not take it, and take 1 dose at the next regular dosing time. You must never take 2 doses at once.
Is there any effect from food? Are there drinks I must not have?
There are none in particular. As a rule, please avoid drinking alcohol before and after taking the medication.
I vomited after taking it. What should I do?
If you vomited, avoid taking it again. After vomiting, if you feel better before the next scheduled dosing time, make an effort to take it. Taking it with plenty of water may ease the nausea.
Are there over-the-counter medications or health foods that must not be taken together with it?
Foods containing St. John's Wort may reduce the effect of this medication, so please refrain from them. In addition, supplements and similar products containing minerals such as aluminum, magnesium, iron and calcium may reduce the effect of this medication.
I read an article online stating that PEP is 2 tablets. Is 1 tablet all right?
PEP requires taking 3 types of components, and depending on the medical institution, 2 or more medications may be prescribed in combination to cover all 3 types. What we prescribe contains all 3 necessary components in 1 tablet.
What are the "spare" tablets?
The generic medication we prescribe comes in a bottle of 30 tablets, so the remaining 2 tablets are spares. After taking it for 28 days, please discard them. You may take an additional 2 days' worth, but at present there is no evidence that taking 30 tablets increases the effect.
<Dr. Daisuke Shiojiri>
Director of Personal Health Clinic, Doctor of Medical Science.
At the National Center for Global Health and Medicine (Shinjuku Ward, Tokyo) and at Personal Health Clinic, he provides correct, evidence-based knowledge on HIV, PrEP and other topics related to STIs and STI testing, along with care that stays close to patients' hearts.
Born in Japan but raised in Kenya, Africa, he also holds a medical license there and carries out medical assistance, educational assistance and other activities locally.
He also sees patients at our clinic as a part-time doctor.
