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PEP effectiveness, once a day instead of twice
May 30, 2012

A bit over 4 weeks ago my husband got drunk and had unprotected vaginal sex with a woman he doesn't know anything about while on the road for work, not even her name or how to contact her. I wish he would have at least got her number so we could save all of this by having her tested, but all he could think about was how he ruined his life when he woke up that morning (and mine of course). I sent him directly to the nearest hospital they did HIV testing as well as others, gave globulins and found he was negative for testing (I know this test just says he didn't already have it, which we knew)and put him on Sustiva SID and Combivir BID. We talked about the pills, I decided not to treat him like a child (my mistake) and trusted he knew when to take what after we talked about it.

Between withdrawals and side effects he's been all messed up, and when I counted pills last night to find out how many days he had left I found he'd only been taking the combivir ONCE a day instead of twice. I'm devastated, please offer advice. Did it even do anything or was this last month of putting up with his side effects just in vain? I noticed that he would be really hot, but said he didn't feel like he had a fever, so of course then I worry about ARS too. He went in yesterday for a 1 month test but then I read that if you're on PEP you're at a higher risk for a false negative. We are going to do 3 month, 6 month, and 1 year testing. Is the 1 year necessary in your opinion? Our life is in turmoil and this is just making things harder to take. Your knowledge would be so helpful to me right now. Thank you so much for your time.

Response from Dr. Young

Thanks for posting.

Sounds like you're in a difficult situation.

Combivir (AZT+3TC) should be taken 1 pill, twice daily. It's likely not as effective for PEP (as it would be for treatment of HIV) if taken 1 pill daily, or 2 pills once daily.

There's not much that one can do about it at this point, other than to complete the PEP regimen with the correct dosing. BTW, I don't recommend using efavirenz (Sustiva) as part of PEP, this is because of high rates of initial side effects, and for the possibility of exposure to virus that's already resistant to the drug. Current US PEP treatment guidelines suggest using Combivir with a HIV protease inhibitor.

In practice, PEP does not change the sensitivity or timing of HIV testing. I recommend testing at baseline, 1, 3 and 6 months (though some differ on whether the 6 month test is needed). A test at 1 year isn't needed, provided that there have been no additional possible exposures.

Best of luck, BY



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