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I am not sure of my PEP
Dec 26, 2006

I had penile-vaginal sex with a friend then the condom broke at the begining, then I realised it 1 or 2 mins after, I directly washed with soap then urinate + washed again. The follwing morning went for Hiv Testing I was negatif but I was scared and went to the hospital to ask for a PEP. The doctor gave me only a 3 days coarse of Duovir that mean 1st dose taken at 35 hours after exposure. I took all the tablets for 3 days, then the result from the girl came out positif, so I went back to the doctor and she gave me Duovir for 28 days but for 11 days awaiting the result of the girl, I didn't took anything. Can I be at high risk because of this break of 11 days after initial doses? Also is it a sign of HIV infection or reaction to medicine that after a week of duovir,3 weeks after exposure, I have some short mild fever,fatigue, and few rash on the face? I am in my forth week after exposure, I am so scare and thinking of all the consequenses of this.(my wife, my son etc...)

Response from Dr. Frascino

Hello,

PEP should never be prescribed for only three days! A full course of PEP is 28 days. PEP is most effective when begun immediately after an HIV exposure. It becomes less effective as more time elapses. Most HIV specialists do not recommend PEP if more than 72 hours have passed since the exposure.

I recommend that all folks who have an HIV exposure significant enough to warrant PEP be followed by an HIV specialist, if possible. The HIV specialist can accurately document risk, make sure the optimum PEP regimen is prescribed (this would avoid situations like your three-day course of Duovir), handle any PEP-related side effects or toxicities and arrange for post-PEP HIV follow-up testing.

Personally, I would not have restarted you on PEP 11 days after your exposure.

I'll repost several questions from the archives that discuss PEP and contain the references for PEP guidelines. You might consider printing up a copy of the guidelines for your doctor so that she won't make the same mistake in the future!

Finally, I strongly suggest you level with your wife and consider having an HIV specialist guide the rest of your therapy and follow-up testing. Statistically, the odds remain very much in your favor that you did not contract HIV from this broken-condom incident.

Good luck.

Dr. Bob

PEP - As mysterious as Bush winning two terms Oct 19, 2005

Dr. Bob,

Thanks again for all the work and help you provide for your fellow man...A few questions. PEP...Why is the general population 'in the dark' about this..? If I know about it, would have started it right after potential exposure. Are there any statistics as to how it works, and how successful it is..? Why isnt it spoken about more in the "main stream" literature, etc.etc.

OK, I thought this would be a good topic for all who read...

Time to celebrate with a few drinks, so thanks again for reading..? What is to celebrate, you ask.? Well, Tom Delay's indictment, which may continue to help bring the Democrats back in power.!..

S in Ohio (shhhhh it should go "blue" again as you suggest, in next election)...

Response from Dr. Frascino

Hello Ohio "Blue"-Boy,

Actually, I'm always amazed at how "in the dark" the general population is about HIV in general, and not only about PEP. Then again, our HIV awareness and education programs in the US are woefully inadequate and shockingly puritanical, which may account for some of the head-in-the-sand attitude, apathy and ignorance.

Regarding the latest information on PEP, I'll reprint one of the many posts form the archives. Check it out! And spread the word! Tell your friends, write a letter to the editor, discuss it with your doctor, put a bumper sticker on your car, tattoo the information on your Mr. Happy, whatever . . . .

Yes, DeLay gets two indictments in one week; Frist is under investigation; Rove and Libby won't be far behind. Ohio is now a lovely shade of robin's egg blue and will soon be as blue as the Mediterranean (which is exactly what I'm looking at this very moment)?

Stay well!

Dr. Bob

It's 2005...any changes ? Mar 14, 2005

In 2001 the experts said "The current recommendations state that persons with non-occupational HIV exposures should receive medical evaluations, including HIV antibody tests at baseline, 4-6 weeks, 12 weeks, and 6 months".

Has this window period of 6 months been shortened ? It's 2005 and i would like to know why the antibody testing technology have remained a stalemate and not improved.

It's like going into a coma in 1985 and waking up in 2005, only to find out HIV testing has not improved one little bit.

Response from Dr. Frascino

Hello,

New U.S. guidelines for treatment of non-occupational exposure to HIV (n-PEP) were issued in January 2005. In addition, California also recently issued its own n-PEP guidelines. Yes, there are some changes from the original guidelines however, not in the duration of follow-up testing recommended. Both sets of guidelines continue to recommend follow-up HIV antibody tests out to six months. The full texts are available at:

1. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402al.html (for the US guidelines)

2. http://www.dhs.ca.gov/ps/ooa (for the California guidelines)

HIV antibody testing has gradually improved over the past 20 years. We now have 4th generation assays. That's not to say there isn't room for further improvement, but we certainly have moved farther than "one little bit." Hope that helps!

Dr. Bob



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