JOURNAL
The Use of nPEP to Prevent HIV Transmission
Everybody occasionally partakes in behavior that is potentially dangerous, whether this is intentional, such as casual unprotected sex, or unintentional, such as a workplace injury. The consequences of those actions can be scary, but perhaps the scariest of all consequences is transmitting a life-affecting virus such as HIV – and both of the previous examples could have this result. Of course, there are ways in which you can help protect yourself – avoiding risky situations where possible and following safety advice such as using condoms are a good start – but it’s impossible to avoid every potentially dangerous situation in life. Sometimes, risk of exposure to HIV is going to happen. So is there any way that transmission of HIV can be prevented after exposure? Perhaps surprisingly, the answer is yes. PEP, or post-exposure prophylaxis, is a treatment given to those who have been exposed to a high risk of HIV transmission and it’s used as a preventative medication in order to stop the virus in its tracks.
What is PEP?
PEP is essentially an antiretroviral (ARV) therapy made up of a combination of one to three ARV drugs and is actually the same therapy used to treat HIV once transmitted[1]. Originally only given to occupational exposures, such as needlestick injuries in health care workers, the US Department of Health and Human Services (HHS) offered guidelines in 2005 for the use of PEP in non-occupational (nPEP) cases such as exposure through sexual activity or drug use as well[2]. The treatment is given to those who test negatively for HIV and have been exposed to a high risk in a single case (ongoing exposure, such as a person with an HIV positive partner, is not normally treated with PEP, but with an alternative drug, PrEP – pre-exposure prophylaxis). In contrast to occupational PEP, nPEP is generally coupled with risk-reduction counselling and education in order to help patients learn from their damaging behavior. It is also only administered if treatment is sought within 72 hours of the exposure – any longer than that, and the treatment simply isn’t effective and therefore isn’t prescribed[3].
Modafinil and Neuro-enhancement: Delightful or Dangerous?
What Is It?
Science fiction is abound with neuro-enhancement technologies and medications. The Bradley Cooper film Limitless is just one example, in which characters discover a street drug that allows them to unleash 100% of their brain power, becoming not just more productive but more charming, cleaner, and more energetic. But could such a drug ever exist? Perhaps. Whilst not on the same level as the drug in Limitless, Modafinil is tipped to be the first true neuro-enhancement drug suitable for healthy people.
The FDA approved drug, which is marketed as Provigil in the US and the UK is a schedule IV drug, meaning that you must have a doctor’s prescription in order to legally buy it or possess it[1], although there are plenty of off-label versions of the drug being sold on illegal, overseas websites. At its base, it’s a stimulant that is prescribed to people suffering from sleep disorders such as narcolepsy and is used to increase the cognitive functions of people with neuropsychiatric disorders and shift-work related sleep deprivation[2]. It has later become a nootropic, or ‘smart drug’, taken by healthy people to increase concentration, memory, alertness, energy, and motor skill as well as reducing sleepiness[3].
Doctor Peter Morgan from Yale University explains that it is effective because it acts on several different neurotransmitters at once. It affects your dopamine levels, making you more alert and more interested in things. It affects your norepinephrine, again improving alertness and focus. It affects histamine too, which keeps you awake. It is also believed to enhance short-term memory by as much as ten per cent by influencing the neurotransmitter glutamate[4]. It could affect other transmitters too, meaning that the reaction is different for different people.
That’s a lot of cognitive improvement from one little pill, and the list of people taking it is impressive. It’s prescribed to surgeons who need the boost to get them through long surgical procedures whilst maintaining a steady hand. It’s prescribed to long-haul airline pilots and shift workers. There are also many famous people who reportedly take it to help with day-to-day living. Tim Ferriss, author of The 4-Hour Workweek is one, comedian and actor Joe Rogan is another. Even President Obama is rumored to have taken it[5]. For those not so famous, the internet is littered with case studies and personal proclamations regarding the greatness of this drug and its potential for the future of neuro-enhancement. All this though, makes it easy to wonder: is it just too good to be true?