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Started PEP- Is it necessary in my situation??? (Resubmitted from the Fatigue and Anemia Forum)
Sep 10, 2008

Dr Bob, I wanted to ask you about PEP in my situation. I just began a regimen of Kaletra and Truvada after an unknown potential exposure over the weekend while in Laguna Beach. I performed oral sex on a male friend of mine who is a physician the first night. I know he is HIV negative. The second night, I was among the same group of friends, all of whom are upstanding, responsible individuals. We were all rather drunk and had used cocaine. I ended up hooking up with a different man- I do not recall us fucking, and he also said the next day that we didn't, and that he is negative. At the time we hooked up, I was rather intoxicated, and ended up passing out in his bed. There was another threesome in another bedroom hooking up at the same time. I know two of the others are HIV negative, but I didn't know the third, but he seemed like a normal california twenty-something. My friends all said that he left after the other little escapade in the other room, but I don't know this other kid, so I am not sure. I have the somewhat irrational fear that after I passed out, someone fucked me without me knowing it. I called my doctor to see if I should start PEP and he said that when cocaine is involved, sometimes people don't recall what happened, so he would recommend PEP. I just tested negative two weeks ago, and want to stay that way. What are your thoughts here, and how horrible are the side effects of PEP with Truvada and Kaletra? I so appreciate your expertise here. This is so not normally how I behave. I am beating myself up over what went on this weekend, which might explain my urgent call to my doctor asking for PEP. It was prescribed over the phone without a doctor visit or urgent care checkup... I am donating to your foundation as well. Thanks again for all you do.

Sincerely, Scared Shitless Dave

Response from Dr. Frascino

Hello Scared Shitless Dave,

"S. S. Dave," I'm delighted your question finally found its way to the proper forum. I agree with your doctor that cocaine (and other stimulants, like crystal meth) can increase the risk of unsafe sex, due to the concurrent lowering of inhibitions (common sense) and the raising of one's libido, a perfect storm for increasing STD risk. As for being fucked without knowing it, that's a bit more unlikely. Generally speaking, one would still feel the backdoor effects the next day.

As with all HIV exposures thought significant enough to warrant a course of PEP (post-exposure prophylaxis), I recommend you see an HIV specialist. That specialist would review and document your actual HIV-acquisition risk, review and optimize your PEP regimen (or stop it, if it is not warranted), evaluate and manage all PEP-related side effects and toxicities, evaluate and manage all symptoms that arise during the course of PEP to ascertain if you are experiencing acute retroviral syndrome and finally arrange for and interpret post-PEP follow-up HIV testing.

S. S. Dave, from the limited information you provided, I may not have recommended PEP. (I would need additional information before making a final determination.) PEP needs to be started as soon as possible, and no later than 72 hours, after the exposure. (You don't mention how long your interval was.) Truvada and Kaletra are a recommended three-drug regimen for PEP. Side effects and toxicities vary from person to person. Some folks feel "reasonably" okay while on these drugs; others have a very difficult time tolerating them for the full 28-day course. There is no way to predict how well you will tolerate this treatment. However, the HIV specialist can help get you through a full course of PEP.

Dave, I'm glad "this is not the way (you) normally behave." I was particularly worried about the cocaine use and the alcohol abuse leading to a blackout. Use this as a wakeup call. Alcohol and drug abuse can destroy your health and happiness. I urge you not to let this happen!

Thank you for your donation to The Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's warmly appreciated. In return, I'm sending you my best good-luck karma that your follow-up HIV tests remain negative. Either way Dave, I'm here if you need me, OK?

Good luck. Be well!

Dr. Bob



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