PEP Questions and Timing

[wokkawokka6]

Dear Doctors,

Three weeks ago I had a non-occupational exposure.

A Doctor at a clinic prescribed me Combivir for PEP.

Now, I am three weeks into my treatment. I have been doing more research online, and it appears that many physicians feel that Combivir is inadequate alone for PEP. This of course has me panicked.

Three weeks in, is it too late to add another drug?

How much less effective is Combivir alone than adding the third drug?

What drugs are commonly prescribed with Combivir for three-agent PEP?

Would I take the new drug with Combivir just until the end of the 28 days, continue taking the new drug after the 28 days of combivir have ended, or take both for a total of 28 days together?

Thanks

[Edward W Hook, MD]

This will be your last answer.  Giveing someone PEP is a big deal. Your doctor should be answering your questions.  The sore pectoral muscles however are not a sign of ARS.

The thread is now over.  EWH

[wokkawokka6]

Thanks so much. Drawing blood tomorrow. Physician says he will look at CPK levels related to the chest pain? Do the sore pecs point to ARS?

After this, really over and out :)

[Edward W Hook, MD]

1.  this could be a Combivir side effect.  hard to say and additonal lab tests are needed.

2.  The testing suggeted in these recommendations is standard antibody testing for HIV antibodies.  EWH

[wokkawokka6]

Last follow-up. My physician has referred me to an infectious diseases doctor. Won't be able to see the new doctor for a few days, so I wanted to see if you could provide me some follow-up info.

I have completed my PEP. I have two issues, 1 related to a symptom I felt during PEP, and one related to testing post-PEP.

1. about 10 days after exposure, 9 days after starting PEP, my chest muscles became very very sore. it felt as if I had taken part in a heavy workout, but I had not worked out. My primary care physician indicated to me that he did not have much knowledge re Combivir side effects. He said in reading about Combivir that it can affect lactic acid levels in the muscles and that this may contribute to muscle soreness. I am waiting to also pose this question to the specialist he referred me to. After about 4 days the soreness went away. Now, I admit I am lucky and don't have much experience with the flu and "flu like symptoms". Does this type of muscle soreness (fairly localized I guess) happen in people that take Combivir? Does it happen in ARS patients?

2. In searching around, I see that testing should occur at 6 weeks post exposure, 3 months, and 6 months when PEP is involved. What type of test should I get following PEP? Is any more effective? Are the "quick tests" OK? Why test only 2 weeks following the completion of PEP?

Thanks so much. Over and out.

[Edward W Hook, MD]

Obviously there are no studies evaluating the effects of missed dose. I doubt however that missing a single dose, particularly now after three weeks of therapy, would have much of an effect.  EWH.

[wokkawokka6]

Thank you, the comments are very helpful, indeed. The running theme I think in researching everything is that PEP is assumed to work, but it is just unethical in most regards to run placebo-controlled tests to really find out for sure.

One last question: earlier this week, in the third week of PEP, I accidentally missed a dose by 2.5 hours. I know we must be careful with dosing and timing. How serious do you think such a lapse is?

Thanks!

[Edward W Hook, MD]

Welcome to the Forum.  While some experts recommend three-drug PEP, the CDC continues to recommend two-drug regimens, among which is the Combivir regimen you are on.  For PEP, there is a need to balance cost, side effects and potential benefits.  My own sense is that many health care providers are using PEP without appropriate concern for potential problems that can occur.

Measuring the efficacy of PEP is very difficult and large studies are underway.  Combivir is likely effective and whether other regimens are more effective is unknown and, I suspect,, will not be known for some time, waiting on completion of the trial underway

That said, the regimen you are on is among those that is recommended.  At this time there is no benefit to be derived from adding a 3rd drug.  My advice is to just finish your 28 day regimen of Combivir and to not take any additional medication. The other recommendation that I have for you is to stay off of the internet.  While there is much useful information available on the internet, much of it is also taken out of context or a bit unbalanced and some of it is just plain wrong.

Hope these comments are helpful to you.  EWH