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Me again
Oct 11, 2006

Hey Doc- First off, you really are a wonderful man. It is me of the previous two days posts entitled "Hello again old friend" and "thanks." Day three on PEP after the popped condom with the girl I met at the club. A few questions. First off...side effects. As you recall, I am on Atripla. The side effects have not been too pleasant. After I take it at night I get a kind of stoned feeling. In the morning I am groggy and have been pretty crabby until after lunch time. My mouth has also been very dry. I can't wait for this to be over! I just have a few questions. First off, I know that the normal testing window is three months. Would taking PEP affect the amount of time before I can see a conclusive test? Would PEP be likely to cause false positives or negatives? Secondly, Can I count on the side effects to wear off. Lastly, my mensch of a doctor prescribed PEP for 30 days. Can I stop after 28, or must I go all 30? Is there a difference? As you can tell, I am very eager to be done with this, and hope that after three months, find out all is ok. Very much because of you, I have been able to keep a pretty cool head throughout this, and I am very grateful.

Response from Dr. Frascino

Hello Me Again,

Your questions about nPEP (Nonoccupational Post-Exposure Prophylaxis), nPEP side effects and post-nPEP HIV testing are extremely common to almost everyone undergoing this treatment. That is why I have repeatedly encouraged all folks who have had an exposure significant enough to warrant PEP to hook up with an HIV/AIDS specialist. See my response to your original question below that anticipates your current concerns. The same advice still stands.

To briefly address your questions:

1. The guidelines for testing after nPEP call for HIV-antibody testing at 4-6 weeks, 3 months and 6 months.

2. nPEP side effects vary considerably in severity and duration. Your HIV specialist should be able to help evaluate and manage your symptoms.

3. A full course of nPEP is 28 days.

If you would like to read more about nPEP, I suggest you download the recommendations from the U.S. Department of Health and Human Services report entitled "Antiretroviral Post-Exposure Prophylaxis After Sexual, Injection-Drug Use or Other Nonoccupational Exposure to HIV in the United States." It can be easily accessed on their Web site.

Good luck! I'm continuing to send my good-luck karma that your follow-up HIV tests remain negative.

Dr. Bob

Hello again old friend Oct 2, 2006

Dr. B- Long time reader and many time donater here. I finally thought I got it right and have been exclusively using condoms. On Friday, I met a girl at a club and she came home with me. We had both been drinking. I put a condom on before sex, and it was feeling to good. After roughly three minutes, I noticed that the condom had completely broke. It has been about 48 hours, and because it is the weekend, I have not found an open clinic to get PEP. I am very upset. I know all the stats, but have two questions:

1) Assuming the condom broke immediately, the time of exposure would have been 1.5-3 minutes. Would this be considered a brief exposure (as oppossed to full on sex), and if so, would a brief exposure carry less likelihood of transmission than a long exposure.

2) I am going to look for a clinic tomorrow, but most of the clinics are closed due to Yom Kippur. Assuming the worst, that this woman was positive (she stated that she tested negative in March, but who knows), would you recommend PEP in this situation?

Thanks

Response from Dr. Frascino

Hello,

Welcome back to the forum. Sorry it has to be under such stressful conditions!

To answer your questions:

1. Certainly the briefer the exposure the less the overall risk of HIV transmission. However, even a brief exposure is an exposure and therefore carries some degree of risk.

2. PEP would be offered in this type of situation, but not necessarily strongly encouraged. There are many factors that come into consideration in ultimately deciding whether to PEP or not to PEP the likelihood that the partner is HIV positive, exposure to menstrual blood, the level of concern/worry of the exposed individual, etc.

Regarding PEP availability, any emergency room should be able to evaluate your risk and prescribe PEP, if warranted, to get you started ASAP. If PEP is begun, I would recommend you see an HIV specialist over the next few days to more carefully evaluate your exposure risk, optimize the PEP regimen, handle any PEP-related side effects or toxicities and arrange for post-PEP HIV testing.

One final thought: if you are still in contact with your club-gal, you might ask her to get an HIV rapid test now. If negative, that would very dramatically reduce any chance you contracted the virus.

I'm sending you my best good-luck/good-health karma, OK?

I'm here if you need me.

Dr. Bob



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