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PEP efficacy?
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PEP efficacy?

I just finished my first week of PEP. The side effects are quite severe, but I somehow found a way to arrange with it. Besides, 28 days seem more than okay if it really helps preventing a whole life on anti-viral drugs.

But what I still couldn't figure out is the efficacy of PEP after a "non-occupational" exposure. My risk was unprotected vaginal with a high risk person (though no confirmed to be positive). I started PEP within 55.5 hours.

Dr. HHH, Teak and some others mentioned an efficacy of approx. 90 percent. My doctor anticipated a risk reduction of 85 to 99 percent.

Where do you have these numbers from?

All I could find are some studies that don't give a real clue about the efficacy. Besides most studies I could find refer to an occupational risk, needle injection and so on. The most "suitable" one is probably an animal study from 2001 where a few monkeys received PEP after being "vaginally" exposed to HIV-2. If I understood correctly, all monkeys who were treated within 36 hours remained negative. From the 72 hour group only one (out of 4) seroconverted.

Do you guys have additional information? Are there any more recent studies?

Thanks for your help!
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11 Comments Post a Comment
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Avatar_m_tn
That 1/4 conversion ratio seems too high to me. I thought it would be much lower even without PEP.

Can you tell how you manage with the side effects? Could be useful for everybody.
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Avatar_n_tn
I guess the scientist somehow made sure that in case no PEP was given to the monkeys, they definitely would have got infected. So the 1/4 ratio refers only to the success of PEP. Of course the transmission risk of "normal" intercourse is much lower.

Well, side effects... As in the first days I was extremely tired, the doctors gave me some medicine called Legalon. It contains Vitamin B and protects the liver. Maybe it's also because my body somehow got used to PEP, but I certainly feel less tired. And although I really have no appetite, I am forcing myself now to eat regularly, especially some dairy products like yoghurt and cheese. Also some fruits, juice... Though I couldn't get rid of the nausea, I don't suffer from diarrhea anymore.

Finally, Combivir which I take 2 times per day, seems less severe than Stocrin (same like Sustiva) which I take before I go to sleep. There I always get really dizzy after 1 hour and my dreams a really weird. And in the morning it needs a few hours to feel more or less normal again.

As the doctors always said: Taking PEP is no picnic. If I was not that damn anxious, I wouldn't take it. Saying that I somehow found a way to arrange with it, doesn't mean that I can live a normal life right now. Having a broken leg is more fun than taking these pills.
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480448_tn?1403547723
You should have NEVER been Rx'ed PEP...the risks outwiegh the benefits in this situation.  The meds given for PEP are VERY VERY strong, and can be toxic.  If you had been exposed to a POS person and had a real risk...then the risks would have been justified.

You have no idea as to the real risk you put yourself through taking PEP b/c you were "anxious".
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Avatar_m_tn
I am on the fifth day of Pep and I feel pretty fine beside for occasional Nausea and diarrhea. I am sure you were put on PEP to give you that ease of mind and also, you were put in a high risk situation but the odds are more in your favor since you don’t know if that person was HIV + or not... Fight through the PEP, We have to so that we are sure. I was at a lower risk even though the girl I was with was HIV + (and I only recieved unprotected oral,) and I was still put on PEP. You can be guaranteed that if you started PEP 72 hours after exposure to HIV that you will not get it. Stick with the Meds, I know that my case is only going to get worse, but it is better to be safe than sorry, I would put myself at risk for 28 days. It is just better to be safe. Take this as a huge lesson and if you dodge a bullet, don’t ever put yourself in this position again. Lesson learned. I know this has changed my life forever.
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480448_tn?1403547723
You guys DO realize that you can DIE from PEP?  While rare...it simply isn't worth taking that kind of chance when you've had a NO risk or LOW risk situation.  You should have never been prescribed it.  That's a shame.
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480448_tn?1403547723
You guys DO realize that you can DIE from PEP?  While rare...it simply isn't worth taking that kind of chance when you've had a NO risk or LOW risk situation.  You should have never been prescribed it.  That's a shame.
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480448_tn?1403547723
If I were both of you...I would cease taking it immediately.  I bet the docs in the expert forum would agree as well.
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Avatar_m_tn
I know, Teak has also told me that my doc is a quack (SP). but really, it is worth it to take it, especially worried_sh since he had unprotected vaginal sex. I know my chances are way lower but the medication is free for me so it is better in my situation to take it...
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480448_tn?1403547723
But really...with the risks associated with PEP...it ISN'T in your best interest to take it!  That's just it...unless a person has a REAL exposure to a known POS person, PEP should never ever be an option.  Meds as toxic as those could lead to liver failure, kidney failure, etc.  Your risk of taking the med FAR outwieghs any miniscule risk you had to your sexual partner....whichi in YOUR case...you had no risk at all.

PEP isn't a course of medication to be taken lightly.  It is some serious stuff, especially when you didn't need it.

Your choice though.  Your worried about a risk for HIV (which you didn't have)...yet you are ignoring the very REAL risks that exist to your health by taking PEP.
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Avatar_m_tn
I understand what you are saying but of course there is a risk (in my situation and Worried_sh even those his is scary than my case) My doctor has been in pracitce for 18 years and has given PEP to a buddy of mine becasue he was in a fight, he is fine. If my doctor thought it was a good enough chance to contract it and gave me PEP, than there is obviously something to worry about, especially knowing your partner was HIV positive. Even though he says my chances are under 2%, he still thought it better to put me on it than not on it. I more than likely was not infected and can resume with my Longterm partner but it is better to be safe than sorry.

As for Worried_sh, keep on moving along and by the time you finish PEP, you will be happy you did and feel much safer when you test after that 4 to 6 week period. Rest assured, PEP will take care of HIV if you came into contact with it in the first place :-)
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Avatar_m_tn
Whomever your quack is they aren't following the proper guidelines for nPEP prescribing.
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Avatar_n_tn
I appreciate your comments. I have heard about the guidelines in the US. They seem to be more strict. However, I am not in the US and my German doctor who I consulted via email said that in my situation PEP would at least get considered - though he would not recommend it either.

Thing is that I am in China where the HIV (and STD) prevalence among prostitutes is much higher than in the US. It's hard to get any numbers, but estimations talk about up to 10%. Moreover I am not circumcised which makes the risk again a bit higher. If the in Shanghai predominant subtype CRF A/E ("subtype e") is really easier to transmit seems to be not proven...

Anyway, I know about the side effects. I experience them every day. My blood gets checked every week and so far everything is fine. And as I said already, the side effects are definitely no picnic, but they are somehow manageable. And even if th PEP reduces my real risk only by 50 percent (this is what I still would like to know!), it's worth suffering for 28 days.

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