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mixed status partnership and use of PEP
Jun 2, 2006

Hi,

I'm HIV+, for over 8 years, and I've been on meds for 3 years, they are working well for me, my lastest results are the best ever, cd4 890, viral load undectable.

My first regime included Combivir and Efavirenz,

but after 6months I changed the Efavirenz to Nevirapine.

Since my diagnosis I've only had sex/relationships with other HIV+ men, however recently I met a guy who is HIV-, and would like a more 'active' relationship. I am concerned that there is a risk of infection from various sexual activities, and I'm aware of how to reduce that risk, but my concern is a significant exposure, i.e. a broken condom. If my HIV- partner was to take some of my meds immediatly after a significant exposure, is this an acceptable course of action. Are my meds suitable for PEP treatment, and what should the dosing be, being aware of the side effect profile of Nevirapine.

Thank you in advance, and keep up the good work, your Ask the Experts Forum is an excellent source of information and advice.

Ray

Response from Dr. Wohl

Post exposure prophylaxis (PEP) is reasonable and should work. I would nit use nevirapine. This drug has been associated with severe liver failure when used in health care workers as PEP. Some required liver transplantation. This likely has to do with an immunologic element in the toxicity of this drugs - as suggested by the increased incidence of nevirapine side effects in HIV+ folk who have higher CD4 cell counts.

It would be better, considering PEP is typically prescribed for a 4 week course, if he were to get his own appropriate PEP from his or your doc.

DW



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