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Other Medication During PEP

24 male from UK, 2 weeks ago I was prescribed Combivir as PEP after a risk of exposure with a CSW in Kenya (unprotected vaginal). Started at about 12 hours and haven't missed a dose.

My liver enzymes tested normal at 10 days except ALT at 71 U/L and Albumin at 5.05 g/dl (though from what I've read this may be within normal in most labs for albumin).

Because I'm so remote I was given 2g metronidazole and 1g azithromysin in the event symptoms appear in the field. I was given rocephin 500mg and 7 days doxycycline at 100mg twice daily 2 days after initiating PEP, but am concerned it might be something else causing irritation now.

Is it safe to take the metronidazole and azithromysin course given those measures? AST returned normal. GGT returned normal. Available kidney measures were normal (creatinine just slightly low). Just looking for reassurance of local advise.

It would do a lot for my peace of mind, but don't want to risk unnecessary toxicity.

Cheers,

JB
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239123 tn?1267647614
MEDICAL PROFESSIONAL
Sorry, but I don't have a specific recommendation; I'm not your doctor.  General advice only.  An online forum like this isn't appropriate for specific medical instruction, prescription, etc.  

But I'm glad to have helped otherwise.  Thanks for the thanks.
Helpful - 0
Avatar universal
Would your recommendation be to delay or would your patients be guided to consider a 6 week test conclusive following a PEP course? I understand you are not my provider and I'll consult a GUM clinic upon return, but would love to have a plan in mind and diversity of professional opinions.

Your input is greatly appreciated and has done a lot for my anxiety. Thanks for being available for these questions.
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
PEP is usually optional and its need best judged by professionals knowedgeable about the local prevalence of HIV in patients' partners, what proportion of those might have early or untreated infection (with high viral loads), and so on.  If your Kenya doctor/clinic recommended it, PEP was wise.  However, even in the highest risk situations, HIV transmission probably occurs no more often than once for every several hundred vaginal sex exposures, so even without PEP, the odds were strongly in your favor.

The actual efficacy of PEP isn't known and probably will never be known with precision.  All we know is that it works pretty well in primate animal models and most HIV experts have seen few infections in their patients after PEP.  There is general consensus it is effective, and that the sooner it is administered, the better.  The HIV drugs you used should effective, especially started as soon as 12 hours after exposure.

Anti-STD drug prophylaxis is less common, and usally wouldn't include all the ones you received; as noted above, azithromycin and doxy are redundant -- and in tropical regions, there is a high rate of doxycycline making light-skinned people more susceptible to severe sunburn, which can last a couple weeks after the last dose.  Cover up and use a strong sunblock.

Finally, the extent to which a positive HIV test may be delayed after PEP, if at all, isn't known.  Some experts would delay final testing to an antibody test as late as 6 months after exposure.  OTOH, I would guess a DUO indeed would be valid by 5-6 weeks.  But this is no more than educated guesswork. You should see an expert (e.g. at a GUM conic) for advice about that decision after you return to UK.
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Avatar universal
Thanks so much.

And in terms of Combivir as two drug PEP do you think this is effective? For the other treatments what makes you feel they were likely unnecessary?

I was negative (for everything) at baseline, and will do a rapid test soon, and DUO once I've returned to UK at about 4 weeks. Should I wait until 5 or 6 weeks in light of PEP or is 28 days still conclusive?

Lastly, given that I began at about 12 hours post--and this is a one time incident--would you guess that this is a relatively low risk scenario in spite of the high risk category of potential source? I know statistics don't rule each situation--just hoping for a bit of peace of mind.

Cheers,

JB
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome to the forum.

Ideally questions like this should be directed to the doctor or clinic who prescribed the medications.  But assuming you don't have easy access to them, I'm happy to help.

The bottom line is that you needn't be concerned.  No medications of any kind are known to interfere with the effectiveness of PEP -- there's not even a theoretical reason why they might do so.

Whether you actually need the metronidazole or azithromycin, or needed the ceftriaxone (Rocephin) and doxycycline, is another story. I'm inclined to believe you did not.  The azithromycin and doxy cover exactly the same infections, so certainly both treatments are unnecessary, no matter what sexual exposures you have had. But if you take the additional as recommended, they will not interfere with PEP, and none of them is likely to have any effect on your liver function tests, nor are you at any increased risk of liver toxicity.

I hope this has helped.  Best wishes--  HHH, MD
Helpful - 0

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