Hi Doc

I work at an orphanage in South Africa. While tending to a baby who fell and cut her lip, she coughed the blood into one of my eyes. At her last check her viral load was more than 750 000. She is on ARVs. I started on Aspen Lamzid (Combivir) straight away. The side effects are horrendous. I feel sick all the time, am very tired and light headed. What is the risk of infection? Can I stop the Lamzid before the prescribed 28 days? Thanks a lot! Elani

Hi Elani,

The risk of HIV transmission following a mucous membrane exposure has been estimated to be 0.09%. Consequently, your risk is real, but quite low. PEP (post-exposure prophylaxis) would be indicated. Having taken antiretroviral medications for well over a decade, I completely understand your dislike of the side effects. As with anyone who has had an HIV exposure significant enough to warrant a course of PEP, I recommend you be followed by an HIV specialist, if possible. The HIV specialist would document your degree of HIV risk and review your PEP regimen. He would also evaluate and manage any side effects that might arise. Combivir does contain AZT, which can cause anemia. Anemia is often associated with fatigue and lightheadedness. I would not discontinue your PEP, but the regimen may need to be changed if you are experiencing significant drug-related side effects or toxicities. The HIV specialist will guide you through your course of PEP and also arrange for and interpret your post-PEP HIV antibody tests.

Good luck.

Dr. Bob