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PEP Treatment
Jun 20, 2009

Hello Dr:

I am a 30 yr old male who recently made a huge and stupid mistake by having unprotected anal intercourse with another man. I was the top (insertive) partner and it lasted for about 5 or 6 minutes before I ejaculated inside of him and after ejaculating I remained in him for about another 2 minutes before completely pulling out. I later found out the next day (about 20 hours later) that the individual was HIV+.

So of course I freaked out and I went to a clinic that specializes in HIV primary care and STD testing and the doctor I saw explained to me that my sexual encounter was considered a high-risk situation.

The doctor prescribed Combivir as a PEP for 28 days. I started the treatment within about 40 hours after the sexual encounter and now I am on my third day of the treatment. I would appreciate an answer for the following questions:

1. I have seen some posts from some doctors on this site that believe that an effective PEP treatment for high-risk situations is a three medication approach. One post even mentioned that Combivir alone is not seen by some doctors as an effective PEP treatment. Since I was only prescribed Combivir and no other medication is the Combivir by itself an effective PEP for my high-risk situation?

2. Also, even though I am on the third day of my 28 day course and did start within the 72 hour window should I know be asking for a third medication (i.e. protease inhibitor etc.) to be added to the Combivir to better my odds?

I would rather take every precaution I can (which I should have thought of when I was having unprotected sex)to better my odds with the PEP treatment.

Thanks

Response from Dr. Frascino

Hi,

Why is it that you freaked out only the next day when you learned that your Brokeback Mountain Bottom Boy was positively charged (so to speak)? What if you hadn't found out about his status or if he didn't know his status? Would you have been at any less risk? No, of course not.

Your decision to go commando-Rambo on your partner places you at considerable risk for STDs, including HIV. PEP is warranted. There are a number of factors that go into selecting the specific antiretroviral drugs to be included in a PEP regimen (severity of exposure; source partner's drug-resistance history and current regimen, if known, etc.). Combivir can be effective PEP in some situations, although personally I prefer a three-drug regimen and rarely recommend Combivir. If you were evaluated by an HIV specialist physician, chances are he has his very legitimate reasons for recommending Combivir for you. I would suggest you discuss your concerns with him. A third drug could be added to the regimen (or a total switch in regimens) if needed. You could also get a second opinion if you remain concerned about your treatment. The important thing is that you started some type of PEP reasonably soon after your exposure and well within the 72-hours cutoff. (PEP works best when started as soon as possible after an exposure.) You can read much more about PEP in the archives.

Good luck.

Dr. Bob



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