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Post exposure prophylaxis answers (172)

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Q: 

Lupus and HIV Treatment

A: Response from Dr. Boyle Unfortunately, there is just not enough information provided to answer with any detail; however, if her exposure warrants post exposure prophylaxis under the CDC guidelines I would lean toward continuing it unless she is having some specific problem with it at this time. She should, of course, discuss this with the doctor who provided the medications, especially if she starts to experience a lupus flare, but I am not aware of HIV medications being a cause for that....


Q: 

very confused, should i take hiv drugs without a Poz test?

A: Response from Dr. Wohl Hi Davi- If you sustained an occupational exposure that is risky for HIV transmission you should have been offered post exposure prophylaxis if available where you live. Assuming you did not take HIV medications immediately after the needlestick the proper course is to have repeated HIV antibody tests performed. The CDC recommends testing at 6 weeks, 12 weeks, and 6 months and that is it. Some will test out to 12 months although very, very, very few health care workers who were infected with HIV on the job convert their HIV test from negative to positive after 6 months. There are reports of delayed HIV test conversion when hepatitis C virus is also transmitted during...


Q: 

Blood into eyes, PEP reccomended?

A: Response from Dr. Young Anthony, thanks for your post. You''ve summed up the overall risk of mucous membrane exposures. Overall, it''s quite low- it''s hard to caclulate the effect of rinsing the eyes (or lack thereof). With all PEP time since exposure is the most critical. We generally try to initiate PEP treatment within 48-72 hours after exposure. After that point, the benefit of PEP diminishes. Given your known exposure (if you''re still within the time window), I''d recommend starting PEP. Hope this helps, and best of health to you. BY...


Q: 

DR PLZZZ HELP.....{INDIA}

A: Response from Dr. Wohl I am unsure what you are asking. Did you sustain a needle stick injury? If you were stuck with a needle contaminated with blood you should try at once to learn whether the source patient is HIV+. If this is not known and the needle stick significant (deep puncture which drew blood) then antiretroviral prophylaxis would be indicated if it could be started within 72 hours of the injury. The CDC has produced guidelines for post exposure prophylaxis of blood borne pathogens. Find it at www.cdc.gov. DW...


Q: 

PEP didn''t work. 6 mths later now what?

A: Response from Dr. Cohen Well, sorry to hear that you were not clear about what PEP can do, and the follow up needed. First - while post exposure prophylaxis or PEP is widely done, it is still not clear how well or how often it works to actually prevent infection. But it is clear that it does not always work to prevent infection. Even if all of the meds are ''active'' and there is no resistance, infection can still happen - even within the initial few hours after exposure, infection may happen. So, despite taking antivirals soon after an exposure, some do still become HIV infected. And testing just after completing the meds is not enough as you note - follow up...


Q: 

PEP with no side effects is worrying me! (+donate question)

A: Response from Dr. Young Hello WSIT and thanks for your post. 1. Consider yourself lucky. Many persons experience side effects from post-exposure prophylaxis-- but not all. Just because you''re not having side effects doesn''t mean that your medications aren''t doing the job. 2. One could do a viral load test earlier, but in my opinion, this only provides reassurance, rather than the proof that you might want. Two weeks after exposure might be a little early to test a VL, I''d generally wait until 4 weeks, and don''t forget to continue to get the regular antibody testing in the months to come. 3. As for donations, our new comprehensive HIV care and treatment...


Q: 

switching nevirapine with efavirenz after 2 weeks from PEP

A: Response from Dr. McGowan Please let me provide you with some reassurance. First, you were using condoms which substantially reduces your HIV exposure risk. Second, you were placed on post exposure prophylaxis (or PEP) very promptly (within 12 hours of the exposure). PEP is most effective if taken as soon as possible after probable exposure to HIV. Third, it is important that you test yourself for HIV. In the long run, this will give you the peace of my mind you need. Fourth, you completed the full course of PEP (even if the nevirapine was switched to efavirenz, this would not have negatively impacted the effectiveness of the PEP regimen)....


Q: 

continue testing again.

A: Response from Dr. McGowan Sorry for any confusion. Based on CDC and New York State AIDS Institute (I practice in NY) guidelines for post-exposure prophylaxis after sexual (non-occupational) exposures, HIV testing should be done at 4-6 weeks, 3 months and 6 months after exposure. I hope that helps. Joe...


Q: 

hiv

A: Dear Kaka: Excellent question. Most people who are infected with HIV test positive on the antibody test within six weeks (a month and a half) of infection.  There are tests that can find the virus itself (Qualitative PCR) or antigens (P24 antigen testing) and these are expensive.  There may be some benefit in immediate testing and post-exposure prophylaxis (taking antiviral medications immediately after an exposure); given that it has been some time (a week or so?) since your incident, I don"t know if that would be helpful at this point.    As I noted in our exchange of emails, your risk is relatively small; if it were me, I would use a condom and not expose others...


Q: 

mixed status partnership and use of PEP

A: Response from Dr. Wohl post exposure prophylaxis (PEP) is reasonable and should work. I would nit use nevirapine. This drug has been associated with severe liver failure when used in health care workers as PEP. Some required liver transplantation. This likely has to do with an immunologic element in the toxicity of this drugs - as suggested by the increased incidence of nevirapine side effects in HIV+ folk who have higher CD4 cell counts. It would be better, considering PEP is typically prescribed for a 4 week course, if he were to get his own appropriate PEP from his or your doc. DW...


 
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