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Follow Up re PEP
Sep 28, 2008

Hi Dr Bob.

Thanks for your response to my last question re my exposure to a prostitute and subsequent PEP regime. Its been a nerve racking couple of weeks and the PEP treatment has been absolutely horrendous. I am nauseous, tired, grumpy and fatigued all the time. An ounce of prevention is truly worth more than a pound of cure and I will commit myself to a more responsible sexual lifestyle going forward.

I just had a rapid test done 16 days post exposure and it came back negative. I have read that the new rapid tests are highly antibody sensitive and accurate by 99% after a 14 day window period. The Dr at the testing clinic confirmed this.

My question is three fold:

(1) Is this information on the shorter window period correct? (2)And since PEP suppresses viral reproduction, can the rapid test produce a false negative due to PEP induced low viral count and subsequent low antibody production? Said differently, how reliable is this negative result after a 16 day wait in conjunction with a PEP regiment? (3)Given the type of exposure, vaginal fluid from person of unknown status on non-intact skin on my scrotum, would it be recommended that I can drop the Kaletra and just stick to the Combivir? I do not have an HIV specialist as you always recommend as I am currently living in a foreign developing country that does not have such sophisticated HIV support. The PEP was given to me via a GP family physician.

Thanks so much for your good work Dr. You are helping people every day and are making a difference.

Response from Dr. Frascino

Hi,

1. The newer generation HIV-antibody tests are improved and probably do shorten the window period for most people. However, the guidelines still recommend waiting for the three-month mark for a definitive and conclusive test result.

2. No. The HIV viral load and anti-HIV antibody level are two distinct things. Having an undetectable HIV viral load will not affect a positive HIV-antibody test.

3. You are over halfway through your course of three-drug PEP. If you can tolerate the medication, I would suggest you complete the full 28 days. I really can't thoroughly evaluate over the Internet all the factors needed to make the determination of a two-drug versus three-drug PEP regimen. I certainly appreciate your disdain for the side effects associated with antiretrovirals. (I've been popping fistfuls of antiretrovirals for more than a decade.)

Your comments are an important dose of reality for all our readers who may be under the false impression that PEP is nothing more than a simple morning-after pill that can be swallowed without consequences.

I'm delighted this experience has made you commit to a more responsible lifestyle going forward.

Good luck. Hang in there. You're in the homestretch, OK?

Dr. Bob



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