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PEP failure
I am on my last week of PEP which I started 43 hrs after exposure. I have now developed swollen nodes in the neck area and groin, nothing in my underarms, flakey rash on penis skin, pain in the urethra and a white patch on my tongue. I am very worried that PEP has failed and I am seroconverting. Any ideas from the forum? During my exposure, the condom broke and I did have a scratch on my penis head and that healed in about a day.
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PEP efficacy seems to be a real blind spot in medical circles - much research has been done in treating known exposures to needlestick transfer blood to blood in health workers from known HIV positive patients, where transmission rate is at its most effective - depending on source's viral load and whether a shallow or deep puncture etc etc.

When PEP is prescribed for somebody who has engaged in  risky sexual activity , it should only be done so when there has been an exposure to a confirmed HIV person and its efficacy is very hard to determine because there are less odds of a transmission than by needlestick and various other factors contribute to likelihood of transmission via sexual exposure.

Did you have an exposure to a ***confirmed*** HIV positive person?

I am gathering you were the insertive partner by what you are saying?

Reading a study of 700 people who engaged in risky activity  and received PEP within the required time constraints, about 1% seroconverted - all 7 were gay men who engaged in receptive anal sex (it does not state whether or not they were also IV drug users), 4 of whom had a confirmed HIV pos partner - whether this indicates a failure of the PEP or not is unclear, because even when exposed to HIV there is not 100% guarantee of transmission - and in the particular study some of those who seroconverted engaged in further risky behaviour during PEP and possibly had done so prior to the actual 72hrs PEP regimen, with a completely different source. However the study does not state in detail how many of the other 693 participants had a confirmed HIV source.

http://www.aidsmap.com/en/news/34961E0B-F330-4692-86A8-3CD3F98B9BE1.asp

(this is the most recent data I could find and I think the meds since 2004 may be different)

50% of those who did not seroconvert had not engaged in receptive anal sex, however.


A lot of PEP efficacy research has been done on monkeys. Not so much on humans and you cant do a placebo trial for obvious reasons...

I read another study conducted in Africa where none of those treated with PEP seroconverted (following needlestick and sexual assault exposure) but again no clear pic of prior source status.

PEP, like any drug, cannot be considered 100% effective and does have nasty side effects.

But HIV transmission is not 100% effective either.

Get tested again at the appropriate window.
Good luck.
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Thanks for you reply. Yes I was exposed to a confirmed +ve woman.
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You were also told to test 3 months after your last dose of nPEP.
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what could be the cause of penile rash and urethral pain? Could this also be a sign of seroconversion?
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