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Is It Safe To Switch From PEP To Zidovudine Post Possible HIV Exposure?

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Posted on Wed, 17 Jun 2015
Question: on 25th May I had a brief encounter with a lady whom her HIV status was unknown to me around 6pm Monday. we kissed and she was very wet and I had an erection we were standing by the car, so she had raised he shirt up and i put my penis inside her and thrusted four times then I stopped and pulled out, she went and got water for me and I washed my penis. Today being 27th Wednesday morning she was requesting we made out properly so I had earlier requested for a test before the first incident. Today we ran a test and she was having a double line positive twice and I knew my status which remains negative on the test. after the test I went to consult my doctor and he said I should be careful and and then placed me on PEP. Please tell me what are the odds on this situation explained? My thrusting was 4 times am sure which I stopped.

I am on my 5th day into pep 3 combination but the side effects has been so severe that I was almost stopping the pep, but i held on, hence I want to change to Zidovuden. Can someone please answer me here?
doctor
Answered by Dr. Sankaranantham Murugan (1 hour later)
Brief Answer:
PEP has to be competed for 4 weeks

Detailed Answer:
Hi,
Welcome to HCM.
Thanks for posting your query.

When that girl is HIV positive, the risk of HIV transmission can not be ruled out without a test on appropriate time. Thrusting four times is not the mater. Just a contact also has risk. At the same time all the contacts were not necessarily infectious always. The test done to you is not reliable as you are in window period. PEP also would be effective when it is started as early as possible. Side effects of the drugs and intolerability may likely to become lesser after few days.
So try not to stop the present regimen. If not possible change the drugs with the guidance of your physician. He/she may alleviate the side effects by adding some supporting drugs. So complete the PEP. You will be free from HIV.
Dr. S.Murugan
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Sankaranantham Murugan (52 minutes later)
When you say my test was not reliable that I may be in window period? I tested last month last of last month and I have not slept out if not this case which was like my first and with the exposure as explained. I had had an exposure sometime last year August that I had full sexual intercourse with a lady and only found out that she was positive. I started with Zidovuden same day and completely course without side effects and I have been fine. So in this regards I came to my sense and stopped monday 7pm and she tested wednesday i started the 3 combination wednesday 3pm but then the side effects has been so severe i could not function i felt heavy,overloaded ,nightmare,moods, confused, forgetful,and many more. i managed to push it to the 5th day today. so a hiv specialist i spoke to asked me to meet her so she will help give me script to get truvada that it had less side effects. i asked why not zidovuden she says its very simalar with zidovuden and i will have less side effects. am sacred am worrried, am hypertensive i dont know what to do .what have i coursed myself .my kids my wife...i am just alone and lonely in worst. i dnt know what next....last time i suffered great deal and came free . now am in great fear. dr are telling me the pep is extra precaution but not all sex leads to infection. am worried.
doctor
Answered by Dr. Sankaranantham Murugan (54 minutes later)
Brief Answer:
Zidovudine with another two drugs tried for PEP

Detailed Answer:
Hi,
Welcome back.
All exposures were not necessarily infectious. Spouses of HIV positives remain HIV non-reactive in spite of their regular sex contact for years together and they are called as Discordant couples. So there is likely chance for you to remain HIV free.
You had not mentioned what exactly your three drug combination contained. It would usually include Truvada combination. Depending upon the third drug (Effavirenz or Lopinavir) your symptoms have to be managed.
Zidovudine alone is not recommended for Pep. 3 drug combination is said to be more effective. Zidovudine along with other two drugs can be tried as PEP.
Dr S Murugan
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Sankaranantham Murugan (1 hour later)
I meet a hiv specialist who was on her way oversea and she prescribed truvada for me. She said Efavirenz has terrible side effects. She said they don't give the 3 in one for pep. So I will get the med later and continue with the pep. She says same thing that I should be fine after last dose. That my odds are good and with pep it's much lesser again
doctor
Answered by Dr. Sankaranantham Murugan (51 minutes later)
Brief Answer:
uninterrupted PEPwould be more effective

Detailed Answer:
Hi
Welcome back
Previously there were two types of regimen were for PEP. Basal regimen (2 drugs), extended regimen (3 drugs). Now PEP has only three drugs regimen only
Side effects of Effavirenz or Lopinavir may be severe only for few and not for all.
Pep would be effective only when taken uninterruptedly.
Dr S Murugan

Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Sankaranantham Murugan (2 hours later)
Yes I intended on continuing the pep, but was just to change the 3 combination to the truvada? And continue from an hour early when I started the 3 regimen then take it every morning until it's complete 28days. Please advise because the specialist here said I should buy the truvada then kick start immediately I buy it then take it every morning same time until 28days complete. Please advise
doctor
Answered by Dr. Sankaranantham Murugan (22 minutes later)
Brief Answer:
continue and complete Truvada alone for 28 days

Detailed Answer:
Hi,
Welcome back
Truvada plus Lopinavir (2 tablets twice daily) is the ideal combination. If you are not able to get Lopinavir tablets, continue Truvada alone once daily as.per the old regimen. Dr S Murugan
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Sankaranantham Murugan (18 minutes later)
Alright am going to buy the truvada now and start it off same time and continue until 28 days. Today was my 6 day so I will continue with truvada for the next 22 days.
doctor
Answered by Dr. Sankaranantham Murugan (1 hour later)
Brief Answer:
HIV risk is almost nil if the compliance is 100%

Detailed Answer:
Hi,
Welcome back
If you had started PEP within 12 hours after the risk activity, your riskfor HIV is almost nil if you complete the course of PEP.
Dr S Murugan
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Sankaranantham Murugan (8 minutes later)
In this case I started it in about 40hrs or so, so am in high rate from what you say here Dr? Even as am on pep still
doctor
Answered by Dr. Sankaranantham Murugan (32 minutes later)
Brief Answer:
Not 100% safe, a negligible risk is there.

Detailed Answer:
Hi,
Welcome once again.
PEP can be started within 72 hours. After which it has no value as the disease got established in the presence of an infection.
If you had started PEP by 40 hours, I would not say you are 100% safe . But when you complete the PEP, I would say your risk is low and you protection is around around 90-95%. It means that you are having a negligible risk.

Dr S.Murugan
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Sankaranantham Murugan (12 minutes later)
Please don't understand the meaning of negligible risk ?
doctor
Answered by Dr. Sankaranantham Murugan (31 minutes later)
Brief Answer:
unlike mathematics, in Medicine things can not be predicted exactly.

Detailed Answer:
Hi,

Medicine is not mathematics to have constant answers or fixed answers. When started a little late than 12-24 hours the PEP safety may likely to vary slightly and 100% safety can not be assured. That being said, we consider the risks of infection after complete PEP treatment as very negligible.

Dr S.Murugan
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Sankaranantham Murugan (17 minutes later)
Dr at what ratio have you had or have infections like related to my odeal? I don't know what to say but am in the balance. I just pissed on my pants. I don't know where and how my life is heading. My kids, my wife, I have just messed up so much
doctor
Answered by Dr. Sankaranantham Murugan (5 minutes later)
Brief Answer:
nothing to worry. you would be safe with PEP

Detailed Answer:
Hi
Welcome back
There is nothing to get panic.
The odd is less than 0.5 % slip with PEP.
Not to worry.
Dr S Murugan
Note: Get personalized answers to your HIV related queries You can choose to talk face to face with your doctor. Book a Video Call now.

Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
Answered by
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Dr. Sankaranantham Murugan

HIV AIDS Specialist

Practicing since :1974

Answered : 3109 Questions

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Is It Safe To Switch From PEP To Zidovudine Post Possible HIV Exposure?

Brief Answer: PEP has to be competed for 4 weeks Detailed Answer: Hi, Welcome to HCM. Thanks for posting your query. When that girl is HIV positive, the risk of HIV transmission can not be ruled out without a test on appropriate time. Thrusting four times is not the mater. Just a contact also has risk. At the same time all the contacts were not necessarily infectious always. The test done to you is not reliable as you are in window period. PEP also would be effective when it is started as early as possible. Side effects of the drugs and intolerability may likely to become lesser after few days. So try not to stop the present regimen. If not possible change the drugs with the guidance of your physician. He/she may alleviate the side effects by adding some supporting drugs. So complete the PEP. You will be free from HIV. Dr. S.Murugan