Stribild as Pep

[PePQuestion]

Earlier this week I stupidly had unprotected vaginal sex with a csw.  After the incident there was a small amount of blood on the head of my penis.  I am unaware of her status.I thought the best thing to do would be to go to a Dr. and see if they recommended PeP. 

20 hours after the incident I went to see a Doctor.  The Doctor I saw did not seem very knowledgeable about HIV.  She did not know if PeP was warranted, but luckily there was an HIV specialist in the same office.  She discussed my situation with him and his recommendation was that I start PeP immediately.The specialist told my Doctor to prescribe Stribild for 30 days. 

I know Stribild is a new drug, and I was not sure if it had been approved as a PeP treatment.  I asked her why this particular drug was prescribed, and she basically didnt have any knowledge of HAART.

After doing some reading, I see that Truvada+Kaletra (or Truvada alone) is a commonly prescribed PeP regimine.  I know that Truvada is part of the Stribild combo, but Im not sure why this was the specialists choice? I saw that there is an ongoing clinical trial with regards to Stribild as PeP, which would mean that it is not yet approved for such purposes? 

My questions for you are:  Will Stribild even be an effective PeP treatment?  I dont want to take HAART unless it will be useful in my situation.  Due to the ongoing Clinical Trial, it appears the effectiveness is not yet known?  Isnt the standard regimine 28 days and not 30?

I took the first dose 25 hours post exposure.  I just took my second dose.  The side effects are moderate so far.  I have a headache, a great deal of fatigue, and loose stools.  I just generally feel like I have an awful hangover, but Im assuming it gets better.  I can handle the side effects, but I just want to make sure there is value in continuing treatment.  What would you recommend?

[Edward W Hook, MD]

As I said above, for most the use of PEP is ultimately a personal choice.  If you are asking my advice, I would not have recommended PEP for you before you started it.  This recommendation would be based on your rather low risk for infection as described above, the possible side effects of the medicine and the cost.  At this point cost is no longer and issue and you have an idea of what the side effects are going to be (they may get better over time or worse), so the question now becomes how concerned are you?  As I said above, your statistical risk for infection is low.  

I hope this helps.  EWH  

[PePQuestion]

So would you recommend I stop the PeP course?  I dont want to do long-term damage to my body if I was not at significant risk.

The Doctor did take kidney and liver tests and those came back normal.  Is the window period around 6 months after I finish the PeP course?

I have insurance, so the cost was not meaningful to me.  However I did ask the pharmacy what the out of pocket cost would be, and they said $2700!

I am really conflicted if I should continue the meds or not.

[Edward W Hook, MD]

Welcome to our Forum.  I'll be happy to comment.  First,  your exposure is not one that I would have recommended PEP for.  You did not know the status of your partner and, unless there is something you neglected to mention, it is unlikely that your partner had HIV. further, even if she did, the risk of infection from any single exposure is less than 1 in 1000.  (also, FYI, the fact that she may have bled on you during sex does not meaningfully change your risk as opposed to unprotected sex and exposure to genital secretions).  PEP however is a personal choice and, as you know, all too many doctors are willing to prescribe it not knowing much about the drugs they are prescribing.  

As you have learned from your research however, Truvada alone is one recommend PEP regimen.  Thus des[ite the absence of a clinical trial of this specific medication, since your Stribild contains Truvada it is reasonable to assume that Stribild  would be effective as PEP.  whether the PEP is given for 4 weeks (28 days) or 30 days really does not make any difference.  

I hope that this comment is helpful to you.  Just for my interest, how much did your 30 day supply of Stribild cost?  EWH