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Missed PEP Dose and Testing
May 13, 2004

Hi,

I am currently on PEP for a (non-sexual) exposure taking Epivir,Kaltera and and Zerit. (First 2 days were on Combivir until my doc switched me).

At 15 days into the program, I was late with one dose by about 8 hours. Is this a major cause for concern? Is there anything I should do?

Also, how does PEP impact the testing regime I should face?

One option seems to be a PCR test, but I'm concerned that such a test has a very high risk ofgiving a false positive - as chances are that I will in actualhood be negative.

BTW appreciate all of your answers and hard work here today. As for many people, the CDC people were pretty rude to me.

Cheers,

Response from Dr. Frascino

Hello,

From personal experience, I can attest to the fact that strictly adhering to HIV medication dosing and food requirements is extremely challenging. Being eight hours late on a single dose of your PEP two weeks into the four-week course is not a major cause for concern. It does not require any specific action or change in plan.

Regarding testing, the CDC guidelines suggest medical evaluations, including HIV-antibody tests at baseline, four-six weeks, 12 weeks, and six months following an HIV exposure significant enough to warrant PEP. PCR (viral load) testing is not recommended during PEP, because the antiretroviral drugs would decrease the viral load to undetectable levels.

I'm not sure what to say about the rude folks at the CDC, but since it's part of the government, perhaps it's just the nasty attitude of our current misguided administration trickling down through the ranks. I'll once again suggest they increase the Prozac dose in the water cooler used by those manning the info-hotlines.

Good luck with your PEP.

Dr. Bob



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