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Help me Rhonda!!
Feb 14, 2009

I mean Bob. Dear Bob, It's that pesky med student again. Can I ask one more question?

I had a high risk exposure December 12. Partner's status unknown, but very high risk behaviour. I didn't mention in my last post that I had take a 28 day course of Combivir (I'm not sure why, but this is all they would give me). My symptoms started a few days to a week after my last dose.

I've had no rash but low grade fevers, night sweats, generalized lymphadenopathy (and I do know where lymph nodes are, etc), and no sore throat. Some fatigue but it hasn't been extreme. Myalgia, and fairly severe tingling in the my arms, sometimes torso as well, which started a week or two after the other symptoms.

I'm really terrified. I haven't been able to to think about anything else since these symptoms started 5 weeks ago.

Here's my question: I had a negative rapid test yesterday (8.5 weeks, 5 weeks after onset of symptoms).

I haven't been able to get a PCR at any of the places I have visited. Should I just keep waiting for 13 weeks and then 6 months, or should I fight to get a PCR (and risk confidentiality breaks since my PCP also teaches at my university).

Any advice would be so welcome.

Response from Dr. Frascino

Hi,

My advice to medical students (who may or may not be able to identify normal from abnormal lymph nodes, even if they know where they are!) is exactly the same as it is to non-medical students. If you've had a high-risk exposure and taken a course of PEP you should get post-PEP HIV antibody testing at six weeks, three months and six months after the date of exposure. HIV PCR RNA or HIV PCR DNA is not recommended for routine HIV testing for a variety of reasons that you can read about in the archives. Finally, I'm assigning you, as a medical student, some homework! Download and read the entire Department of Health and Human Services/CDC guidelines for use of PEP in sexual and injecting-drug-use exposures. The information will come in handy during your medical career and will also address any other issues you may be worrying about concerning to your current situation. While you're at it you should also download and read the guidelines for occupational exposures as well. Be prepared for a pop quiz next time you write in.

nPEP: www.cdc.gov/mmwr/PDF/rr/rr5402.pdf (Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States Recommendations from the U.S. Department of Health and Human Services)

PEP: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm (Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis)

Good luck.

Dr. Bob



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