Question

Hi Doctor. I had protected sex with a sex worker in Thailand. The condom overall appeared to be well intact. But am just worried if It may have been slipped/torn very marginally that it missed my attention )

Seeing Me panic, My doctor has prescribed duovir and efavir for 30 days. But I am very scared after reading side effects on the Internet in many forums. Some of this side effects (Steve Johnson syndrome?) look even fatal. I hv now completed 48 hrs after exposure. I have another 20-22 hrs to start them. Please advise

Answer

Hello and thanks for posting your question about HIV PEP.

HIV risk after insertive vaginal sexual exposure is low (about 4 in 10,000, according to the CDC), and with a properly used condom is substantially lower.

I would classify your risk as negligible and therefore would probably have not recommended PEP in the first place. Moreover, here in the US, efavir (efavirenz) isn't generally recommended for PEP (indeed, it's no longer recommended for initial treatment of HIV either), as it's tolerability isn't great (including risk of psychological side effects and rash) and the possibility of diminished effectiveness if the virus you were exposed to harbored drug resistance.

The CDC's HIV nPEP guidelines has nice tables about risk and the algorithm for initiation of treatment.

Hope that's helpful, BY