Dear Dr. Frascino,

I'm a Physician Assistant and was stuck by a needle while suturing a HIV+ patient. His viral load was undetectable and CD4 850. I immediately washed the area and took Combivir within 5 minutes. I've been on the Combivir for one week now and having a difficult time with the side effects. I don't know if I can complete the full 4 week course. My question is, how was the 4 week duration of PEP established? Does it truly take 4 weeks to abort the virus?

Thanks for your time.

Hello,

Your occupational exposure is less risky than most, because as suture needle is solid and your patient had an undetectable HIV plasma viral load.

The 28-day course of PEP was chosen because four weeks of ZDV (AZT) appeared to be protective in occupational and animal studies. However, in reality we really do not know what the optimal duration of PEP therapy is.

Your post brings up another important point for our readers: PEP is no picnic. Taking potent antiretroviral drugs can be very challenging. I speak from personal experience, having taken fistfuls of antivirals daily for over a decade.

Good luck, Physician's Assistant! If you're having difficulties with side effects or toxicity from your Combivir, talk to your HIV specialist. He should be able to help mitigate the symptoms or, if necessary, switch your therapy.

Dr. Bob