PEP Symptoms

[J562]

Hi Dr.

Seven days ago I had protected vaginal sex with a female sex worker. I was only inside her 1-2 minutes before stopping the sex. She put the condom on me. She removed the condom from me  and discarded it. I did not have the opportunity to see if the condom was intact. I would normally check but she just did it so darn fast.

I know my risk is very low. Almost nonexistent if the condom was intact, correct? I think I would be able to feel a major tear. If there was a slight rip in the condom, how much does that raise risk? I should have just looked at the condom before she removed it from me.

Anyway, a physician at a clinic told me I had minimal worries. But he said he could give me PEP Combivir BID for 28 days. I filled the prescription and began 6 days ago, 22 hours after the sex incident.

I have since had the following side effects / sensations:

1. Pretty bad knee pain. Chronically.
2. Almost zero appetite for 3-4 days. It has come back a little the last two days.
3. Waking up with nausea pre-morning Combivir dose. Nausea bad enough to actually wake me, but not bad enough to make me vomit. Need to lay down though.
4. Fatigue.
5. Stiff neck last night. Only one side. It has subsided.
6. I had the mild *twinge* of a sore throat. Gone
7. Headache. Pretty bad these last two days. Not earlier in the PEP dosing though. I never get headaches, and these feel significant.

Does the Combivir point to any of these symptoms? I realize the light sore throat and neck pain are probably unrelated.

Do any of these point to HIV seroconversion? Would the Combivir lessen the side effects of seroconversion? Or is it an "all or nothing" type thing, where I would be getting full-blown symptoms of the PEP was not working?

If I finish the treatment of Combivir and my liver/kidney function fine, are there any longterm implications of the 28-day course of the drug?

Thanks, and once again I am only 6 days out.

[Edward W Hook, MD]

I still follow the guidelines for PEP followup in my patients which the PEP was warranted (yours was not).  There are still not enough data available to feel comfortable changing the approach.  Earlier testing might be reliable but there are just not enough data to be sure.  EWH

[J562]

Hi Dr., hope the Holiday Weekend treated you well.

One follow-up question (not related to PEP side effects):

I have read other posts of your suggesting that the guidelines for HIV testing windows are outdated by a few years because of advances in testing methods and technology. In other words, that one can reasonably get more conclusive results sooner than the guidelines would suggest.

I believe the standard for testing post PEP is 6 weeks after exposure (so 2 weeks after the conclusion of PEP) and then at 3 months and 6 months.

Do these guidelines still hold true today, in practice? How long after PEP should I wait for a test, and which type of test should one have after PEP? Are some tests more disposed for a false negative after PEP, and at what time intervals?

Many thanks!

[Edward W Hook, MD]

Yes, joint pain can indicate otehr severe systemic illness. That however a still raises the question.  Why are you asking me when you should be asking this of the person who wrote the prescription.  You need to take these issues to him or her.  EWH

[J562]

Thanks so much. My PI for Combivir indicates that the joint pain is a severe side effect of the drug and requires medical attention. Do you have any idea why the joint pain would be a severe side effect? The adverse experience table in the PI lists musculoskeletal pain as occurring in 12% of subjects.

Many thanks!

[Edward W Hook, MD]

No, none at all.  EWH

[J562]

Thank you Dr.

Assuming no HIV, is there any problem with stopping the combivir cold turkey in the middle of the PEP course?