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PEP - Please Help!!!!...very worried
Nov 9, 2004

Hi Dr, You seem to the the only medical expert who gives straight answers, which I appreciate. About 5 days ago, I engaged in insertive vaginal sex with a high risk individual. Before this, she had stimulated me with her hands using baby oil. I know - stupid me I thought this was safe, which ofcourse now I find out is not. We did use a condom, but I did have quiet a lot of baby oil on my before the condom was put on. So we had sex, and I didnt specifically notice the condom break. Next day I realise how stupid this was, and speak to an HIV specialist who tells me I can take PEP if I want to although not really advised in this situation. So I begin PEP - Combivir at 6pm, about 18 hours after the incident. As I am told to take the tabs twice daily, I only took the next dose the next day at about 9am. Now these are my questions. Do you think the incident is a significant exposure. I have read the archives but there is conflicting info. You state that if the condom did not break - no additional risk. Other doctors on the forum state the oil based lube could have easily caused microscopic holes ?? Secondly, the insert in the medication as well as the doctor told me to take the COmbivir twice daily and not miss a dose, which I have done however, i had a gap of about 15 hours between my first dose and second dose. I didnt realise it had to be taken every 12 hours strictly, and realise this could have completely jeapardised the effect of the PEP. If it should be taken exactly or very close to 12 hours, why dont they state it as many people would probably take it with a fairly longer or shorter gap. From 13 hours or so the drug oculd have lost a lot of affect ( I read AZT had a very short half life). I would really appreciate your insight. Someone from GlaxoSmithKline told me it should be taken every 12 hours, so cant understand why they dont state this on the drug insert!!

Response from Dr. Frascino

Hi,

Thanks for your kind comments.

Regarding your situation, I agree with your HIV specialist PEP would not be advised based on such a minimal degree of risk.

True, we recommend water-based lubricants. And also true, oil-based lubricants can weaken latex, making it more likely to tear. However, in the situation you describe, there is minimal to negligible risk.

Moving on to your specific questions:

1. Significant exposure? No.

2 Combivir should be taken twice per day, but a strict 12-hour interval is not required. Your "15-hour gap" is not a problem. Other drugs, such as Crixivan, which is taken every eight hours, have much more stringent dosing and time requirements. For example, Crixivan must be taken every eight hours, not merely three times per day.

Hope that helps clarify things for you.

Good luck!

Dr. Bob



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