Dear Doctor, I had an unprotected sexual exposure to a person in mid April who had a high likelyhood of being HIV positive. I approcahed my primary doctor the next day and he, not being an HIV expert, started me on Combivir, Kaletra, and Viread (Tenofovir) for PEP. I took all of them as prescribed for 2 weeks but was having too many side effects (GI, acidosis etc) and had to stop Kaletra after 2wks but continued and finished Combivir and Viread as prescribed for 28days. For the last few months since stopping my meds I have been having mirgratory bone pain, upset stomach with bitter metallic (not like GERD) taste in my mouth, generalized weakness, and 2 "knots" that have shown up on my body that are painful (one on my R mid scapular region and one just in front of my R ear (not responsive to NSAIDS or muscle relaxant). My latest tests were done 3days ago on Sept 4th (a little over 20wk post exposure and 16wk post PEP) that showed a negative HIV-1/2 Ab ELISA, and an undetectable (<100) HIV1 RNA level. So I doubt that HIV is the cause for these symptoms. However I am concerned over the toxigenicity of these drugs. I know that they are fairly new and not well studied and the regimen that was prescribed to me was probably a little overkill. But are you aware of the above meds having any carcinogenic potential or other side effects that might explain my symptoms. Please make any recommendations on what I should do from this point.. Thanks for your help. -A

Hello A,

You were prescribed Combivir, Kaletra and Viread for PEP???? Hmmm . . . consider yourself lucky that your GP didn't know how to write a prescription for "kitchen sink" as well. Overkill? Yeah, I'd say so. Perchance does your GP use a machete to mince a clove of garlic??? Situations like yours are exactly why I have repeatedly suggested that anyone who has had an HIV exposure significant enough to warrant a course of PEP be followed by an HIV specialist. HIV/AIDS specialists would evaluate and document your level of risk, prescribe and/or optimize PEP if warranted, evaluate and manage all PEP-related side effects and toxicities and order and interpret post-PEP HIV testing.

I cannot diagnose the cause of your various symptoms over the Internet. It is doubtful they are related to your PEP. Also PEP does not have any known "carcinogenic potential;" otherwise the drugs would never have been FDA approved.

I agree the symptoms you describe are not HIV related and also that your chance of being HIV infected is nearly nonexistent. Finally, I strongly agree that your primary care doctor is not an HIV expert! I do not agree with his choice of medications for PEP or using RNA PCR for routine screening. If he can't help identify the cause of your ongoing complaints, you could consider getting a second opinion or another primary care physician altogether. To be frankly honest, based on what you've told me so far, I'm not very impressed with the one you currently are using.

Good luck.

Dr. Bob