Oct 15, 2007
Hey Bob- I got a question for you. I wrote in a few weeks ago. About 15 seconds of unprotected oral with someone confirmed positive. No ejaculation. It has been 14 days. I have had no fever, no cough, no sore throat, no rash. May have had a few swollen glands, but nothing too severe, and I self diagnosed with a lot of prodding. Anyhow, I am going on vacation on the 24th, which will be my 24th day of PEP (atripla). The side effects have been pretty bad at times, particularly if I have a few drinks or dont get a good night sleep. I know that you would not have recommended PEP in the first place in this situation, but, putting that aside, here is my question. I would really like not to be on PEP during my vacation. While I am aware that the recommended time for PEP is 28 days, is there any reason to believe that 24 days of PEP would be less effective. I do not know all the science of it, so I would like your advice before deciding whether to just do 24 days so I do not have to be on PEP on my vacation. Please advise whether you think that 24 days of PEP would be significantly less effective than 28 days, and if so, why.
Also, is there any reason that it would be less likely to experience ARS symptoms (and still serocnvert) while on PEP?
Does PEP, if it fails, have any effect on the time for seroconversion, or would a three month test still be recommended.
Thank you Bob.
Response from Dr. Frascino
So let me get this straight. From my last response you know that I would not have recommended a course of PEP for your 15 seconds of oral sex, but you took it anyway and now you want my advice as to whether you can stop it four days early, because you want to booze it up while on vacation. Have I got that right, Mike? Are you looking for more advice not to follow? Mike, if I wouldn't have recommended PEP in the first place, why would I mind if you stopped it prematurely?
As for your other question Is 24 days of PEP less effective than 28 days? the logical answer would be "most likely yes." Otherwise the routine recommended course of PEP would be 24 days, right? However, I should point out that in reality we don't really know how much or even if the difference in efficacy between 24 and 28 days is significant, because we have never studied it. The 28-day course was based on our best estimate for optimizing the chance PEP would effective. Mike, my advice to you remains unchanged:
1. PEP would not be recommended.
2. If, despite that recommendation, you take PEP, you should take it as directed and get the post-PEP HIV follow-up tests out to six months per the published guidelines.
Mike, the advice is straightforward. The choice to follow it or not is up to you. Following it only partially, due to convenience, would, in my opinion, finish a distant 3rd place in the question of to PEP or not to PEP!
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