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PEP toxicity

Oct 26, 2008

Hello Dr. Bob,

I had a high risk exposure in Aug and was put on Combovir/Viread for 28 days (at the 41st hour). I have tested negative until now, with the latest being a PCR and Elisa at 5 1/2 weeks post Pep. I was also tested for other STDs and everything came out ok. Unfortunately though, my urine analysis showed microscopic amount of blood in my urine (some white cells and red cells). My doc set a follow up appt. for me in three months, but Im wondering if I should see a urologist sooner. If so, do I need to disclose my being on PEP? Also, could a 28 day course of PEP cause a ymptom like that. PS: No painful urination or anything like that and my CBC test was normal as well. Thanks in advance Dr. Bob!

Response from Dr. Frascino


The first step in evaluating a routine urinalysis that reveals "microscopic" amounts of blood and some white cells is to repeat the test, making sure it is collected properly ("clean catch mid-stream sample"). If the abnormalities worsen or persist and your general medical doctor isn't willing to evaluate the problem, then a referral to a urologist should be made.

Regarding kidney/urine-related problems possibly linked to antiretroviral medications, tenofovir (one of the components of Viread) can be associated with renal toxicity. However, it generally would not be a problem after only a 28-day course of therapy. Should you mention your course of PEP to the urologist if you have a urology evaluation? Sure. Why not? Taking a course of PEP is nothing to be ashamed of! Hiding information from your doctors is never a good idea.

Good luck!

Dr. Bob

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