It can usually spot HIV infection 23 to 90 days after an exposure. There has been no reported case of delayed sero case since 1990. Immunocompromised patients with COVID-19 may not have detectable levels of antibodies, or have a delayed antibody response. (Some, but not all, infections may be detected at this stage). Monitoring during PEP A person who is receiving HIV PEP should have the following tests after the first dose (within the first few days): One-time rapid HIV antigen/antibody test Hepatitis B (Hep B antigen test) You can share your reports through this platform if you feel comfortable. UK guidelines state that 45 days is the window period for fourth-generation laboratory tests. A protein substance (immunoglobulin) produced by the immune system in response to a foreign organism. 21 October 2008. Created for people with ongoing healthcare needs but benefits everyone. Does PEP delay the window period this much? Key enzymes of this pathway are pyruvate:ferredoxin oxidoreductase (PFOR) and 2-oxoglutarate:ferredoxin oxidoreductase (OGOR), which are responsible, respectively, for the reductive carboxylation of acetyl-CoA to pyruvate and of succinyl-CoA to 2 . How accurate are fourth-generation combination tests for HIV diagnosis? Aidsmap. Antigen/antibody tests done with blood from a finger prick take longer to detect HIV (18 to 90 days after an exposure). Use your card to shop at Ackerman's, Shoe City, Refinery, and Dunns. Started pep for 28 days after 9 weeks of exposure.Will it affect to detect HIV after window period if HIV transmitted? Condoms are the most effective way to prevent HIV and STDs. Visit other versions in US, UK, Australia, India, Philippines and Home Thanks. 169 Tower Bridge Road, Then started skin itching (commonplace is upper back but no visible rash) sometimes had formication. The sooner you start, the better it works every hour matters. If the test is negative at three months and there is no further exposure, there is no need to repeat the test. PEP is a 28-day, three-drug regimen. Comment. Aquifex aeolicus is a microaerophilic hydrogen- and sulfur -oxidizing bacterium that assimilates CO2 via the reverse tricarboxylic acid cycle (rTCA). Related: All topics, PEP/PEPSE. NAM Publications 2023, all rights reserved. Taking PEP or PrEP do[es] not interfere with either the HIV fourth-generation antigen test [which is typically used in routine HIV testing, and checks for both antigens and antibodies] or the viral load test, Blick says. PrEP is used by people with high risk to prevent HIV infection. Didn't scroll down far enough. 554 Burket's Oral Medicine. Aducanumab (Aduhelm) has received accelerated approval as a treatment for Alzheimer's disease from the U.S. Food and Drug Administration (FDA). Yes Not every unprotected sexual encounter is treated the same way by doctorssome are considered riskier than others. Can you get HIV from casual contact, like hugging? so that's why i was considering to take the PCR test. if yes then when would be the best period for conclusive testing? Similarly, self-samplingwas not included. Our current tests may not be sufficiently sensitive or discriminating to detect HIV infection when the levels of HIV antigens and RNA may be suppressed by PrEP, and the resultant antibody response to them is very weak. Then again at three months post exposure to be sure. http://i-base.info/qa/factsheets/hiv-transmission-and-testing. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. A fourth-generation laboratory test is recommended in UK and US guidelines. PrEP can be taken as an oral pill or received as an injection every two months. According to the Centers for Disease Control and Prevention (CDC), there are a few different types of HIV tests: Most rapid HIV tests and at-home HIV self-tests are antibody tests, and they usually require either an oral swab or a finger prick. At this stage, it is highly likely that a negative result is accurate. Then after four months of exposure (the second girl, because I think the first girl cleared HIV, she did HIV test this month and it is negative), I did HIV antigen and antibody CIMA test and HIV antigen and antibody p24 all negative. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. All patients need a negative HIV antibody test (4th generation Ag/Ab recommended) prior to initiation of PrEP. So, for starters, PEP stands for Post-Exposure Prophylaxis. Another name for antibodies. All Negative except HSV 1 (It is positive for 15 years). No self-testing deviceswere included in this study. PrEP is used by people with high risk to prevent HIV infection. . It usually involves taking daily oral medications for four weeks beginning shortly after an exposure happens. The oldest floret lies in the periphery . Before we get into the thick of how PEP and PrEP impact HIV testing, lets better understand how HIV works and how PEP and PrEP prevent HIV infection. People who are living with HIV take these medications for treatment, to stop HIV from creating more copies of itself within a persons body. Find out more: Are HIV tests accurate in people taking HIV treatment, PrEP or PEP? Get answers from Infectious Disease Specialists and top U.S. doctors, Our doctors evaluate, diagnose, prescribe, order lab tests, and recommend follow-up care. Third-generation laboratory tests are no longer recommended for use. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. Tests cannot always detect HIV infection during the window period. Gigi Engle, ACS, is a certified sex educator, sexologist, and author of All The F*cking MIstakes. There have been few studies of PEP on antibody production. 1. does pep delay antibody test. 1) Complete blood count, LFT (liver function test), serum creatinine. For most practical purposes, in November of 2017 when I'm writing this, PEP means a 28-day course of Truvada, the only medication approved by the US FDA for use as PEP. 3) Regarding the penile lesion or prostatitis history which you mentioned reflects other STI (sexually transmitted infection) which share the same route of acquisition (unprotected sexual contact anal, vaginal or oral). Our information is intended to support, rather than replace, consultation with a healthcare professional. The best advice we can give is to follow CDC guidelines and speak to your health care provider if you are concerned. Most are based on second- generation tests, so are likely to have relatively long window periods. Window periods are likely to be several days longer when testing samples of fingerprick blood or of oral fluid, as will be normal when using rapid, point-of-care tests and self-testing devices. The efficacy of postexposure prophylaxis (PEP) in healthcare workers exposed to HIV was first reported in a case-control study in which one month's therapy with zidovudine after percutaneous or mucous exposures to HIV was associated with an 81% reduction in the risk of HIV infection [1]. Consult a doctor now! 3) Your HIV tests are also negative after about five months of last unprotected exposure. I experienced condom breakage. I am first going to mention the best part of the complete description given by you: 1) Both the partners, with whom you had exposure, were tested HIV (human immunodeficiency virus) negative. By using our website, you consent to our use of cookies. Individuals who are taking pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) may have a delayed antibody response, extending the window period. However, the key word here is mayas in, although PEP or PrEP may delay the HIV antibody test window, it is not guaranteed to do so. If you don't get. It blocks the virus at one stage of replication, says Alicia Morehead-Gee, M.D., the medical director of HIV prevention at Altamed Health Services. For these, please consult a doctor (virtually or in person). The test can provide information about how your body reacted to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). PEP delay the window period ?? On June 24, 2021, The U.S. Food and Drug Administration . When HIV enters the bloodstream (usually through unprotected intercourse or needle sharing), it latches on to a type of white blood cells called a CD4 cell. The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. Why is sunflower not a flower? 12 weeks? Facebook As the body is beginning to make antibodies to HIV, a person may test "indeterminate" (that is, not clearly positive but not clearly negative, either) on an HIV test. Frequency of HIV testing depends on your risk. People on PEP or PrEP may have a delayed antibody response, which would extend the window period for an antibody test.. Cookies and privacy - It isn't an awesome situation, because the scientific literature basically says that a better test needs to be developed. Is testing for hiv on the particular day the window period ends good ?e.g testing on day 45 after exposure with 4th generation test and testing on day 90 after exposure using rapid test ? PEP can delay the body making antibodies. Is HIV detectable after window period (3 months) by hiv-antibody test if pep is taken after 8 weeks of exposure assuming HIV is transmitted? 274 Madison Ave Suite 705 New York, 10016. Understanding a Positive Result, CDC. PCR tests are not diagnostic tests. You will be able to test from 6 weeks after your last dose using a 4th generation antigen/antibody test. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. This indicates that half of all infections would be detected between 26 and 37 days after exposure. But some HIV medications are approved for use specifically by people who are not living with HIV to help them avoid getting HIV in the first place. Thank you for taking the time to confirm your preferences. version 12.066-7-prod. 35 means we can empower more people living with HIV to challenge stigma with our information workshops, videos and broadcasts. COVID-19 antibody testing is a blood test. Nonetheless, a study by Dr Kevin Delaney and colleagues calculated window periods for a range of HIV testing assays. Above mentioned tests will help to identify other STIs or any other chronic ailment. Saving Lives, Protecting People, Centers for Disease Control and Prevention, U.S. Department of Health & Human Services. A day after the condom broke (6/6/21), I tested negative on oraquick. A person who is receiving HIV PEP should have the following tests after the first dose (within the first few days): After PEP has been completed, a one-time fourth-generation HIV test is necessary. 108 However, in contrast to HCV, it appears to not be . Frequency of HIV testing depends on your risk. Plasma is extracted from the sample using centrifugation. This is because PEP can delay infection. All these analyses were based on plasma samples. Copyright waiver - Hello I had my 12 week HIV Rapid antibody test last week (it was an INSTI test) and it was negative. does pep delay antibody test. Would a 2-1-1 (on demand) PrEP, in which 2 tabs of Truvada before sex exposure and 1 tab for next 2 days after exposure, increase the window period for 4th gen HIV test? Time Until Emergence of HIV Test Reactivity Following Infection With HIV-1: Implications for Interpreting Test Results and Retesting After Exposure. Yes I had PEP at day 12, and the most important thing I want to known is the accuracy of those tests. 107 The Maltings, I do believe symptoms & hiv tests can be delayed due to PEP. Individuals who take PrEP or PEP are usually tested for HIV regularly, so that they may start treatment immediately if they are found to have HIV. For PrEP specifically, Morehead-Gee recommends that a person gets checked for HIV every three months while they are taking PrEP, to make sure that they remain HIV-negative while on the medication.. All tests have a window period, the length of which depends on the marker of infection (HIV RNA, p24 antigen or HIV antibodies) and the specific test used. They can detect immunoglobulin G (IgG) antibodies and immunoglobulin M (IgM) antibodies. Aducanumab was the first therapy to demonstrate that removing beta-amyloid, one of the hallmarks of Alzheimer's disease, from the brain reduces cognitive and functional decline in people living . This type of incompatibility usually does not affect the first baby but affects subsequent children. Would a 2-1-1 (on demand) PrEP, in which 2 tabs of Truvada before sex exposure and 1 tab for next 2 days after exposure, increase the window period for 4th gen HIV test? Am I at the risk of HIV? How does the pharmaceutical industry differ from other industries? There are two key questions to ask about a specific HIV test: The information given in UK testing guidelines about window periods is based on answers to the second question specifically, how long after exposure to HIV 99% of infections will be detected by a specific type of test. Hi Dr. There is more on HIV testing here. As these two substances are detectable sooner after HIV infection than IgG antibodies, second-generation tests have longer window periods. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. PEP can be stopped at any time without tapering the medication dose. PEP (post-exposure prophylaxis), CDC. Over time, in the absence of HIV medications, HIV hijacks the persons immune system: HIV copies increase and CD4 cell count decreases. This table shows the most common side effects and the percentage of people who experience them: See a doctor in person See a doctor via telemedicine, 274 Madison Ave, Suite 705New York, 10016, The chance of getting HIV with the kind of sexual encounter you had (youre more likely to get HIV from some sexual activities), The amount of time thats passed post exposure, Treatment should be started within 72 hours of exposure, Ideally, it should be given within the first 24 hours after exposure, Once the decision is made, the first dose should be taken, Unprotected sex with an HIV-positive partner, Its convenientit only has to be taken once a day, Its a better medication for a drug-resistant HIV virus, Not taking the medication as prescribed (missing doses), Delay in starting the medication (ideally it should be initiated within the first 24 hours, but it can be started within 72 hours of exposure), The test usually remains negative because HIV has a window during which infection is not detected, The HIV virus may be falsely suppressed while someone is on medication, People may (unwisely) stop taking the medication because they assume theyre negative after a few negative tests within during the 28 days theyre on PEP, Their partner agrees to be tested and tests negative for HIV, A negative rapid HIV test (fourth-generation antigen/antibody) is usually enough, A negative HIV RNA is necessary if new infection suspected, Their HIV-positive partner has an HIV RNA test showing suppressed virus (undetectable viral load). Frequency of HIV testing depends on your risk. Both are available by prescription. But its unnecessaryheres why: The above information applies to all types of HIV testing: the fourth-generation antigen/antibody test, HIV RNA test, or antibody test. HIV infection has a window period of one to three months during which these test results may be false negative Read full, .. to know a few more details to answer your query better: It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. Thanks? what is the window period after the last dose of PEP? The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. I have Googled it and can't really Hello, I went to an STD clinic to get tested. Here are the most common reasons for a PEP regimen failure: Here we summarize the testing necessary before starting PEP, post-treatment testing, and testing needed during PEP. My doctor instructed me to continue taking it as prescribed. After high risk contact, Day 12 i tested the RNA virus load PCR test (40 copies) resultnot found. Didn't find the answer you were looking for? After this, it is recommended that they get tested again at three to six months post-exposure to fully confirm that they are HIV negative, according to Chanel Marshall, M.S., an HIV health educator with Inova Health System. I believe I have chlamydia prostatitis. Meanwhile, for PEP, the CDC states that people should be tested for HIV immediately after completing their course of PEP medications (usually about four weeks post-exposure). Started PEP on the 60th hour (it was Hi - sorry I missed your question earlier. Post-exposure prophylaxis (PEP) may help prevent HIV infection. This proves that ginger is a stem, not a root. If I was exposed to HIV and then took PEP, would this affect your confidence in a negative antibody test after six months? You take PEP 1-2 times a day for at least 28 days. (Plasma is the colourless fluid part of blood, separated from whole blood using laboratory equipment. Then the very first day started PEP but took 24 days only. Never disregard or delay professional medical advice in person because of anything on HealthTap. Here are the two most important criteria for PEP treatment: Lets talk about each of these in more detail. Can you get HIV from casual contact, like hugging? In some situations, these figures should be interpreted with caution: British HIV Association, British Association for Sexual Health and HIV and British Infection Association. If the result is negative, get a confirmatory rapid HIV antibody test at three months of last exposure. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. With Gift Aid, your generous donation of 10 would be worth 12.50 at no extra cost to you. be started as soon as possible after the patient receives a positive COVID-19 test and within 10 days of . While on Acyclovir, around three months back, I had a penile lesion but settled within seven days. It can typically tell you if you have HIV infection 10 to 33 days after an exposure, though some tests can detect infection within a few days. Emergency drugs called post-exposure prophylaxis (PEP) may prevent HIV infection. This stands true in your case as well, even if you had taken PEP (postexposure prophylaxis). U.S. Information on this website is provided by treatment advocates and offered as a guide only. Does Truvada extend the window period for HIV antibodies to show up on testing? These cookies may also be used for advertising purposes by these third parties. Result was negative on 8 weeks. Older comments. The following are considered high risk: If youre not in either of those categories, you can decide whether to be on PEP by looking at your statistical chance of getting HIV (based on the type of sexual activity you had) and your personal wishes. By using this Site you agree to the following, By using this Site you agree to the following, The Best IOL for 2022 RXSight Light Adjusted Lens, Will refractive surgery such as LASIK keep me out of glasses all my life. Antigen/ antibody tests done with blood from a finger prick can take longer to detect HIV (18 to 90 days after an exposure). Within 1 day. Theroratically it can delay. Does PEP delay seroconversion? http://i-base.info/qa/what-are-the-most-asked-questions, http://i-base.info/guides/testing/pep-pepse-and-prep, AFTER MY PEP 28DAY I WAS TESTED NEGATIVE DOES THAT MEAN I AM FREE FROM HIV, No, pls see the FAQ page: The estimated window period for INSTI when testing plasma are as follows: However, those estimates were based on testing plasma. PEP is not 100% effective, but it is very effective if taken consistently and correctly. What side effects did you have on taking Ciprofloxacin? We cant seem to find the page you were looking for. I would retest at six weeks after exposure. Terms of use - 4) VDRL (venereal disease research laboratory test). Experts can't agree on whether to use COVID-19 antibody tests to check whether people need a booster shot. We offer this Site AS IS and without any warranties. 99% of HIV-infected individuals would be detectable within 50 days of exposure. In very rare instances, it has been reported that in some people where PEP had failed, they took longer than the usual 6 months to test positive on an antibody test. Why routine multiple HIV tests are unnecessary during PEP. PrEP works by blocking the HIV virus from replicating in the body. Doctor's Assistant: Have you seen a doctor about PEP? Combined HIV antigen and. Again five months ago had intercourse with a condom (but oral sex without a condom). *The number of people who engage in the activity, unprotected, who contract HIV. Doctors typically provide answers within 24 hours. A negative test result at 6 weeks does not completely rule out the possibility of becoming infected with HIV as you will still be in the window period. This website sets no cookies from us or anyone else. Did you have any fever with your symptoms? :(. but i took pep, i understand, the windows starts after finishing PEP, am i wrong?, if so, my test were only 3 weeks. And HIV RNA was negative. I think the window period exeends. In addition, PEP and PrEP wont impair the accuracy of HIV tests themselves. Condoms are the most effective way to prevent HIV and STDs. Dolutegravir is preferred for two reason: No clinical trials on non-occupational post-exposure prophylaxis have been conducted. Any donation you make helps us continue our work towards a world where HIV is no longer a threat to health or happiness. It is believed that it is more than 80% effective. It also depends on the specimen that is being tested: window periods are usually reported based on a sample of blood plasma, but are longer when the specimen tested is fingerprick blood or oral fluid. Comment navigation. So maybe that would be your case. 1) The recommendations are to get tested at four to six weeks of last unprotected exposure by a rapid fourth-generation HIV combo test. February 2022. All information these cookies collect is aggregated and therefore anonymous. Delaney KP et al. This indicates that half of all infections would be detected between 22 and 31 days after exposure. Statistics - Fast Facts, HIV.gov. By: Admin Posted on August 15, 2022. May 25, 2021. Have you used any medication for it? Their window periods are similar to those of the INSTI third generation rapid test (plasma samples), but a little shorter (median 23 days). She did frotting against my rectum, I have several fissures that do b After exposure I did a 4 weeks PEP , waited for complete 6 weeks making it 10 weeks post exposure before testing with Alere Determine Hiv 5 weeks ago, I met a girl from another college (23 years old), and decided to have protected sex. The window period of rapid, point-of-care tests and self-tests is 90 days. It also can show how your body reacted to COVID-19 vaccines. Just asking another question since my initial one received no response. PEP is a series of pills you can start taking very soon after you've been exposed to HIV that lowers your chances of getting it. Should I repeat it later? Post navigation. Thanks? I had a potential exposure on April 10th.next I confirm covid positive on April 24 th .then I did 46 days nd 56 days ofter hiv 4 th generation test.result non- reactive .covid nd post covid status can a increase hiv window period .pls tell me ? At the following link * Dr. Robert Frascino writes: Babies who are born to HIV positive mom may have the antibodies for up to 18 months but they may still not have HIV. Theroratically it can delay. The FDA said on May 19 that antibody tests shouldn't be used to test for. A CCP antibody test requires a blood sample. 6 months? Emerging Putative Viruses. I am planning to do another Oraquick test at 90 days. This type of test requires a blood draw from the vein, so it needs to happen at a health care provider. Q.10. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. Will post-exposure prophylaxis alter the results of fourth generation HIV test? MedHelp is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. Conference on Retroviruses and Opportunistic Infections, abstract 565, 2018. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. check an HIV 4th gen Ag/Ab test while on week 4 of PEP and prescribe PrEP so the patient can start PrEP the day after PEP is completed. Therefore CDC post PEP follow up testing guideline has been reduced to 12 weeks post exposure except in case if the person acquired HCV. There has been no reported case of delayed sero case since 1990. The best test to know whether or not you were exposed to HIV is the viral load testHIV-1 RNA PCR testwhich can measure particles of HIV within 48 hours of exposure, he tells TheBody. Where is your pain mostly, near your anal region or along the urethra? Post-exposure prophylaxis (PEP) may help prevent HIV infection. Getting Tested for HIV, CDC. Antibody test: This is also a blood test that is sent to a laboratory. Many rapid, point-of-care tests are described as second generation. Can I get HIV from surfaces, like toilet seats? We recommend that individuals get tested prior to starting PrEP or PEP, Morehead-Gee notes. Copyright 2023, iCliniq - All Rights Reserved A DAT is performed on the blood of a baby to determine if the antibodies have attached to the baby's RBCs.This may occur when an Rh-positive baby is born to an Rh-negative mother. Both hepatitis G virus (GV) and GB virus C (GBV-C) represent two coincidentally discovered isolates of the same virus. Never disregard or delay professional medical advice in person because of anything on HealthTap. The expression mean of MGL_1781 gene was 103.919 7.5 in test group. Although four days short as per mentioned guidelines, it will be considered adequate in your scenario. by subcutaneous injection when IV infusion is not feasible or may delay treatment. Company limited by guarantee. The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. We work to change lives by sharing information about HIV & AIDS. HIV produces an antigen called p24, which is present. Please give your opinion. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. Any (both insertive and receptive) unprotected vaginal or rectal sex or exposure to blood or bodily fluids mixed with blood is considered high risk. Call your doctor or 911 if you think you may have a medical emergency. NAM is not responsible for the content of external websites. Most HIV rapid tests and HIV home tests use. Registered charity, number: 1011220, Image: ANURAKE SINGTO-ON/Shutterstock.com. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other commonly abused medications. The PCR test is essentially an HIV viral load test. - J. Biochem. We offer this Site AS IS and without any warranties. All tests have a window period, which varies from test to test. In very rare instances, it has been reported that in some people where PEP had failed, they took longer than the usual 6 months to test positive on an antibody test. Related: All topics, HIV testing, PEP/PEPSE. This ensures anyone who is positive will test positive. . Can I get HIV from surfaces, like toilet seats? Antibody Test An antibody test can take 23 to 90 days to detect HIV infection after an exposure. The sooner you start, the better. I had a potential exposure on April 10th .next I confirm covid positive on 24th .then I did 46days nd 56 days ofter HIV 4th generation test . What is the difference between PrEP and PEP? should not change the window period. Is PEP extending the window period for antibody testing? Time from HIV infection to earliest detection for 4 FDA-approved point-of-care tests. Skin itching started the very next day of the Covishield vaccine. The answer is: yes, potentially, but its not likely. Centers for Disease Control and Prevention. April 9, 2021. What would you say would be the conclusive window period after taking PEP? HIV is a viral infection that attacks the immune system. How doctors decide whether to recommend PEP. Persons being evaluated for PEP because of a sexual encounter should have STI-specific nucleic acid amplification (NAAT testing) for chlamydia and gonorrhea, and a blood test for syphilis Hepatitis B testing, including hepatitis B surface antigen, surface antibody, and core antibody Hepatitis C (HCV) antibody Read our Editorial Process to know how we create content for health articles and queries. I was hoping someone could help give me clarity on my situation. Visit NAMs other websites: clinic.nam.org.uk|infohep.org|prepineurope.org|about-hiv.info|pro-vich.info | hiv-lens.org. This chapter provides practical information on HIV post-exposure prophylaxis (PEP) and will help you make a decision about whether PEP is for you.