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Only started with Keletra
Aug 20, 2011

I had brief bare back exposure to a high risk individual this past early saturday morning. I believe his penis was only slightly inside of me, and I don't believe it was for very long (maybe five minuits). I did not intend for him to be inside of me at all, but apon disenaging I felt the sensation of him pulling out from a lot further in than I thought he would be. I was very intoxicated, but I very rarley bottom and am very sensative to it, so even if the person is in me a tiny bit for me it seems they are in almost completely, so I do not believe he was in me very far.I am also sure he did not ejaculate. I am not sure however, if there was any pre-ejaculation. All of this however,is uncertain because like I said, I was very intoxicated so my memories of the event are not very reliable. I do not know what his HIV status is, but what freaked me out is when I saw him using a needle to inject meth shortly after our encounter. I did not recieve treatment untill Monday evening, when I visited Urgent Care. I know it was stupid for me to wait that long. One of only many stupid decesions I made over the weekend. The urgent care doctor only perscribed be Keletra as PEP, and nothing else. I was not very educated about the subject, so I did not question this decision. I took my first dose about sixty five hours after the encounter, barley with in the 72 hour window. It was not untill two days later when I saw my primary care doctor that I was given a perscription for Atripla in place of the Keletra. This was Wednesday afternoon, and I received my first dose of Altripla at this time. From Monday untill Wednesday afternoon I had been taking only two pills of Keletra twice a day. So my question is how effective was only taking the Keletra to start? Am I able to hope that it at least did some good to combat any infection? Or was it useless because it was an incomplete PEP regimen? And if so, does it do me any good to continue with PEP at this point?

I very frustrated that a doctor working in an Urgent Care facility in a gay community in a large city would be so unfamilair with PEP protocol, but I am more frustrated with myself for my complete reckless and foolish behavior that landed me in this position in the first place.

Response from Dr. Frascino

Hello.

I agree lopinavir/ritonavir (Kaletra) monotherapy is not a currently recommended PEP regimen. However, PEP protocols can vary somewhat from medical center to medical center and haven't had a guideline-based update in quite some time. As it turns out Kaletra monotherapy is actually quite active against HIV in some groups of chronically infected HIVers. Consequently it's quite possible Kaletra monotherapy might work for PEP. But this has not been formally evaluated and therefore I cannot advise exactly how effective Kaletra monotherapy would be for PEP. I would advise you complete your 28-day course of PEP and proceed with post-PEP HIV testing out to six months per the guidelines. I would also suggest you contact the medical director at the urgent care facility and discuss what transpired. Treatment facilities should stick to recommended guidelines for prescribing PEP.

Good luck.

Dr. Bob



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