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I don't know what to do next...

May 1, 2003

Hello, I was just diagnosed HIV positive this past week and remember getting infected about 6 weeks ago so I really don't know what kind of advantage I am at. I don't really know where to start. I went to the doctor initially because I had had a unsafe sexual episode where after the fact my partner told me has was positive. Because he told me the same day I went to enroll in a PEP program and had just started a 4 week program of Sustive, Zerit and Videx this last Monday. But when I went in this past Monday my doctor told me my tests had come back positive and I wouldn't be able to complete the abortive type of PEP program I was on but suggested I still take the meds I was on while I undergo some more tests. I really have no idea what steps to take next. I just really need some more info. I don't know where to turn. I live in NYC and know there are many places to turn but with everyone having a different opinion as to what my next step should be I just really wanted to get as much information as I possibly can. I'm really scared and just want to make the right choices.

Response from Dr. Wohl

If I understand you correctly, it took 4 weeks to start post exposure prophylaxis following your exposure. If so, that is too long a delay. If you sought help immediately after your exposure and were forced to wait, this would be an outrage.

If 2 weeks ago your HIV antibody tests were positive, I would not continue you on HIV medications, especially the ones chosen for you. There are no data that I am aware of that starting therapy so close after seroconversion (when antibody test goes from negative to positive) offers any benefit over waiting to initiate therapy when the CD4 cell count drops below 350.

Videx and Zerit together don't generally mix and I avoid this combination except under special circumstances. I would never offer them together as part of a first line regimen.

Lastly, are you sure you were recently HIV infected? Could it be that you have had the virus longer than you believe?

I'd discuss with your clinician your very real concern regarding a) not getting PEP directly after exposure, b) the use of HIV therapy so soon after possible seroconversion, and c) the use of Videx and Zerit together. This clinician may not be the one you want to continue seeing. At the least, get a second opinion from one of the many excellent HIV treaters in NYC and consider getting off these drugs and then getting your CD4 and viral load checked if they were not originally before you started therapy. Let us know what happens. DW

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