I finished taking a month-long course of PEP (combivir and nelfinavir) on the 25th August, after possible exposure as the receptive partner of anal sex with a man of unknown status.

One week before completing the course, I developed symptoms including fever, sweats, sore throat, fatigue and swollen glands. I continue to have these symptoms (one month later) and antibiotics (doxycyline) have not made any difference. One month after possible exposure, I tested negative, however I have to wait for another 7 weeks before the clinic will do my next HIV test. Do you think my symptoms indicate that the PEP was not effective? Is it likely that the PEP itself could have weakened my immunity? Do you think I should request for another HIV test sooner than 7 weeks?

Hello,

Regarding PEP (post-exposure prophylaxis), the treatment, while certainly helpful in decreasing the chances of HIV transmission, is not 100% effective. There are indeed PEP failures (yours truly, for example). That is one of the reasons I recommend that anyone who has had an exposure significant enough to warrant PEP should be evaluated and followed by an HIV specialist physician. HIV specialists are best trained to evaluate the need for PEP, optimize PEP regimens, manage PEP-related toxicities and side effects and interpret post-PEP HIV studies. You could add to this list that HIV specialists would also be best in recognizing and managing PEP failures.

To answer your specific questions:

1. Symptoms are notoriously unreliable in predicting HIV infection. Consequently I would not jump to the conclusion your PEP was ineffective.

2. PEP does not weaken immunity.

3. Not necessarily. If you are being followed by an HIV specialist, I would suggest you discuss your concerns with him. Specialized testing is available that could help determine if someone is seroconverting in the post-PEP period; however, without additional information, I cannot determine whether I would recommend such testing in your case. Chances are good I would not, and instead would advise that you continue to follow the guidelines for post-PEP HIV antibody screening.

Good luck.

Dr. Bob