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PEP -- Why 28 days?
Sep 18, 2002

After a possibly risky sexual act (unprotected brief anal sex, as the top or insertive partner), I started PEP (Combivir), first dose 36 hours after possible exposure. Everything I've read tells me I should take the pills twice a day for 28 days. But I've also read (on this site) of some people being given three meds (rather than two) for 14 days. I'm a little confused by that, could you clarify? What is the rationale behind the length of the 4 week prophylactic treatment?

I'm also suffering from quite a bit of fatigue during the day (I'm on day 16 -- having missed one dose inadvertently on day 14), probably exacerbated by the fact that I'm also on an antidepressant known to cause fatigue in some, Effexor XR, dose 150 mgs. How do I counter this fatigue? Would it be reasonable for me to quit the Combivir after 21 days rather than 28?

Response from Dr. Henry

The 28 day course is fairly empiric based on what has been used successfully in the past versus what might work just as well. 28 days would far excede the average survival of HIV in the body unattached to any cell. It is likely that shorter courses and/or use of different meds than the standard meds would be just as effective but experts and docs tend not to deviate from an established practice without good data (hello lawsuit!). KH

A question about PN.
Hemophiliac with HIV

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