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Has PEP regimen guideline been revised since 2009?
Nov 8, 2010

Hello Dr. Bob,

I wrote to you before about PEP due to potential HIV exposure, and you responded with accurate information that not even my primary physician has. I've come to you again for similar consultation, please help me as I'm a little confused by my ER physician's prescription.

Yesterday I had yet another potential HIV exposure: I was grinding and making out with a man I met in the bathhouse, everything was going well until he surprised me by slip the head of my penis into his ass. Both of us had lube on our penis so it slipped in easily. I immediately withdrew, nevertheless my penis was inserted solidly in his rectum for at least one second. He told me he's HIV negative but I know better than to rely on his own comment, especially after his irresponsible action earlier, so I went to a hospital immediately after, where I was offered PEP. I've taken PEP before, and it was Truvada 1 tablet daily, plus 4 Kaletra 50/200mg tablets daily, for 28 days. This time however they prescribed me Truvada 1 tablet daily for 15 days, and 4 Kaletra 50/200 mg tablets daily for 8 days only. I thought this was odd since it differed from the PEP regimen I took just a year ago, but the nurse told me that they're simply following a new guidance which calls for reduced medication in case of moderate risk exposure like the one I had. From your post I learned that PEP is only taken when significant risk is involved, and if so, must be taken for 28 days. If no significant risk is involved, then only an HIV anti-body text at 3 months past exposure is warranted. Has the PEP guidance been already revised since 2009 when I had my last potential HIV exposure?

I do plan to see a HIV specialist for follow up (the same one I saw last year), but in the mean time can you please advise me on the PEP regiment guidance? I'm especially concerned that I may not get to see an HIV specialist before Kaletra run out since I only got 8 days of supply, and most specialist don't have appointment available within such short notice.

I sincerely appreciate all your help!

P

Response from Dr. Frascino

Hello P,

There has been no change in nPEP (non-occupational post-exposure prophylaxis) guidelines. You are correct: a recommended course of nPEP is a full 28 days. Call the HIV specialist and advise the ER doctor did not prescribe the correct PEP dosage. The HIV specialist will most likely call in additional medication or agree to see you before your dose runs out. Please advise the HIV specialist to contact the ER doctor and educate him regarding proper nPEP dosing guidelines!

Good luck.

Dr. Bob



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