● can blockers reduce the risk of infection after high-risk behaviors?
At present, there is very accurate research evidence that taking blockers after high-risk behaviors can reduce the risk of HIV infection. Is it possible to block successfully as long as the blocker is taken? This is related to many factors, including the timing of blocking, which blocker to choose, whether the patient takes the whole course of medication, and whether the patient continues to have high-risk behaviors, etc., so whether the blocker can succeed requires individual analysis and individual treatment. For the success rate of blocking, it is difficult to do a prospective cohort study. According to the retrospective analysis of existing data, after taking blocking drugs, the probability of AIDS blocking failure is about 5 / 1000.
Are AIDS blockers the same as antiviral drugs?
AIDS blockers and antiviral drugs are actually a kind of drugs, and currently the triple drug program is commonly used. In fact, it is related to the process of HIV infection. In the case of sexual contact transmission, the virus first invades the mucous membrane, passes through the mucous membrane barrier, and then enters the tissues, cells and lymph nodes of the human body, and propagates in the lymph nodes, and finally enters the blood. There are several blocking opportunities in the whole process. It is important to kill the virus before it reaches the blood, so as to achieve the purpose of blocking.
Schematic diagram of HIV infection path
● the faster you take blockers after high-risk behaviors, the higher the success rate?
Generally speaking, the earlier the blocker is taken, the earlier the blood concentration of the drug will rise, so as to ensure the effect before the virus enters the blood; of course, if the drug concentration can reach the effect before the virus reaches the lymph nodes, or even before it passes through the mucosal barrier, the success rate of blocking will be higher. At present, the effective time to block is 72 hours after high-risk behavior, the earlier the better, the best within 2 hours.
● if you take more than the best time, do you want to take blockers?
At present, it is believed that the possibility of blocking is relatively small after 72 hours. At this time, the virus is likely to have entered the blood and take blocking drugs again, which is basically the same as antiviral treatment.
In this case, is it necessary to take blockers? I don't think the problem can be generalized. It depends on how 'high-risk behavior' actually works and the specific situation. If it is a direct infusion of blood from HIV infected people, the risk of infection is as high as 92% - 96%, which is a 'very high risk' situation. Even if it has been more than 72 hours, it is recommended to continue to take blockers. Although the possibility of success of blocking at this time is very small, but the medication for early treatment and follow-up disease control, or very meaningful.
● where can I get AIDS blockers? Do I have to pay for them?
AIDS blockers can be obtained in the outpatient department of the hospital. Like our hospital, they can be obtained in the STD / AIDS outpatient department. If they are not on duty, they can be obtained in the emergency department, usually within 2 hours. As for the cost of drugs, if it is occupational exposure, the unit will bear certain responsibilities; if it is non occupational exposure (sexual exposure or other reasons of exposure), blockers need to be purchased at its own expense. Currently, the first choice is more expensive, with a course of treatment of about 56000, and another one is cheaper, with a course of treatment of about 34000.
2. After high-risk behaviors of AIDS, how can blockers be effective? ● what are the blockers? What are the commonly used drug combinations?
AIDS blockers and antiviral drugs are the same. At present, many authoritative guidelines recommend triple drug blockers. In China, although the guidelines have not been adjusted, the common programs are triple drugs. At present, the first choice of blocking scheme is latiravir (integrase inhibitor) in combination with antrapine (nucleoside reverse transcriptase inhibitor) and tenofovir (nucleoside reverse transcriptase inhibitor). Another blocking scheme is to replace latiravir with Coriolus or efavirence, and take it together with antrapine and tenofovir.
Schematic diagram of comparison between latiravir scheme and kriege scheme
Generally speaking, if there is no contraindication and economic permission, latiravir is the best way to block it. Take one tablet twice a day. The side effect of this program is very small, and there will be no discomfort after taking it. However, if the economic conditions are a little bit poor, we can use the Coriolis solution, two tablets twice a day, the side effects of the drug are relatively large. At present, in China, these two schemes are basically applicable to all people. In terms of drug selection, different blockers for human use are different, mainly determined by their own conditions.
● what tests need to be done before taking blockers?
Generally speaking, before taking blockers, we need to do two checks: on the one hand, we need to check the blood routine and liver and kidney function before using drugs to evaluate whether we can use drugs, and the safety of drugs, and determine when we need to reexamine the liver and kidney function after using drugs, and whether we need to increase the number of follow-up visits; on the other hand, because syphilis, hepatitis B, hepatitis C and other diseases and AIDS have Similar routes of transmission, it is necessary to screen whether patients are also infected with these diseases.
● what are the side effects of AIDS blockers?
In fact, the side effects of latiravir regimen are relatively few, which may cause occasional rashes, but the probability is very small; the side effects of Coriolis regimen are relatively large, which may cause rashes, but mainly gastrointestinal symptoms (such as nausea, vomiting, fatigue, anorexia, etc.); in addition to headache, dizziness and other discomfort caused by efavirenz regimen, about 7% - 8% of Chinese people have primary drug resistance, with more restrictions Some.
When these situations occur, we should not worry too much. We'd better go to the hospital and deal with them according to the judgment of professional doctors. However, many people are still afraid that this will be an early manifestation of HIV infection. Indeed, the early stage of AIDS may also have rashes or other uncomfortable manifestations, which is difficult to distinguish from the side effects of drugs. I'd like to emphasize here that it's better not to think about discomfort, because it will only increase psychological burden. During this period, as long as reassuring drug use, and so on after the window period to do the relevant inspection, there is no infection a check is clear.
● if the side effects are really uncomfortable, can we reduce the dosage and stop the medication properly?
If you feel uncomfortable, you can find a doctor, who will help you find a way, but it is absolutely not allowed to reduce or stop the medication by yourself. The success rate of blocking is closely related to the effective and stable blood concentration. Reducing the dosage or suspending the medication will destroy the stability of blood concentration and greatly reduce the success rate of blocking. Therefore, we must not easily reduce the drug, stop the drug, or it will easily lead to the failure of blocking.
Some people will ask, if the drug has been stopped for several days because of the side effects of the drug, and now the drug reaction disappears, and then take the blocker, will it still work? It's hard to say whether it will work in this case. Stopping the drug in the middle will increase the failure rate of blocking, but for the 'very high risk' situation, then take the blocker, although the blocking effect may not be ideal, it has no harm to the early treatment . If there is a similar situation, it is recommended to see a doctor immediately. The doctor should make an individual analysis according to the specific situation, and it is better not to decide by himself.
● what should I do if I don't take medicine late or missed?
It is difficult for us to take medicine for one minute at ordinary times, but the difference should not exceed one hour or two hours. We should try to take medicine at a fixed time to make the blood concentration fluctuate in a small range. If there is a real delay in taking the medicine, as long as it does not exceed half of the interval, you need to take it immediately. For example, latiravir and klitschke are taken once every 12 hours. If you remember to take them directly within 6 hours, it's good. If you take them more than 6 hours, you don't need to take them. You'd better take them on time.
● how long does AIDS blocker need to be taken? Does it need to be taken again after a course of treatment?
Blockers are generally taken for 28 days. According to research data, the success rate of blockers will be greatly affected in less than 28 days, and it is unnecessary to take more than 28 days. After that, monitoring and inspection will be done.
3 during the period of taking AIDS blockers, what should we pay attention to?
Generally, two weeks, one month and three months after taking the medicine, we need to go to the hospital for reexamination, which mainly involves two aspects: on the one hand, we need to monitor the side effects of drugs, all drugs have certain damage to the liver and kidney, generally, we need to check the liver and kidney function after two weeks to ensure the safety of the medicine; on the other hand, we need to monitor the blocking effect, we need to test the HIV antibody at one month and three months to see if it is OK Blocking succeeded.
● do blockers extend the window?
At present, it is believed that taking blocking drugs will not prolong the window period of AIDS, nor affect the accuracy of the test results. Generally, three months after finding high-risk behaviors, we can determine whether we are infected with HIV. If it's occupational exposure, the relevant guidelines in the United States suggest that four months after finding the high risk, it will be more secure. (click to find out: how to deal with emergency after occupational exposure)
● can you have sex while taking HIV blockers?
During the period of taking AIDS blockers, it is better to reduce sexual life, and must wear condoms, which is relatively safe. In addition, it should be emphasized that after taking blockers, it is necessary to avoid high-risk exposure again. Before, we analyzed the causes of blocking failure of some people, and found that they continued to have high-risk behaviors during the medication period, which led to blocking failure. I believe that everyone can understand that as long as the high-risk factors are not completely removed, it is impossible to block success with any good blocker, so we must pay attention to it.