Question
Should I keep a few pills in case I need PEP again in the future?
9 September 2016. Related: All topics, PEP/PEPSE.
Is it a good idea to stop PEP on Day 26 and keep the 2 remaining Truvada and 4 raltegravir pills as “insurance” in case of a future mishap?
I ask because after a condom break and unverifiable HIV status of my sex partner, obtaining PEP was a miserable experience due to emergency room staffing shortages and my travelling.
Most of the stress was in this phase and should I ever need it again, I would like to be able to start within minutes, not after 28 hours. If not advisable, are there starter packs that can be obtained? I know all the stuff about liver testing and verifying HIV before treatment, but if I test negative and only have safe sex, the latter is pointless.
The liver testing could be done after a couple days I’m imagining (anyway, few side effects besides a bit of tiredness) Thanks for a practical answer.
Answer
Hi
Thanks, yes, the short answer is that there are lots of reasons why this might be a good idea and very few reasons not to consider this.
A slightly longer response continues…
There is actually very little data on the effectiveness of PEP. This is mainly because HIV is already such a difficult virus to catch, any study would need to include many thousands of PEP cases to start to see anything significant. So even though some PEP studies report low numbers of infections – often none – these studies usually only include a few hundred people when looking for something that might only have a 1 in 500 chance of occurring anyway.
The study I remember that showed a benefit used starter packs – and this has always made the most sense – especially if someone is at higher risk.
i-Base information always stresses the earlier PEP is started, the better chance it will work. This should ideally be within hours. On this basis, PEP clinics (including general hospitals) would be better to give someone a single Truvada tablet as soon as they walk through the door..
The single pill would start working immediately (FTC is absorbed very fast, tenofovir takes longer). This means PEP could start working while other tests are carried out. In the event that someone might already HIV positive, another med could be given to minimise any risk of drug resistance (ie switching to a boosted PI for two days). Another alternative would be an option to continue HIV treatment, which is increasingly an option on diagnosis.
There is no data to show there is any difference between 26 day or 28 days of PEP, so you can easily do this with little likely impact on the efficacy of PEP. Actually, there is no data showing a difference between 21 and 28 days either – I think 28 days was chosen for practical reasons as much as anything else.
In practice, after a needlestick risk. most health workers report stopping PEP within a week or two. This shows that even people who should be the best informed about PEP, often do not complete the full course. The full course is always recommended.
Either way, holding back a few days of PEP does makes practical sense, especially when health services generally – certainly in the UK – keep people waiting for at least four hours, if not considerably longer. It would also take the uregency and panic out of getting PEP. so that if the incident happened at a difficult time, you could go to the PEP clinic the next morning.
You are right to be cautious about not using PEP in the future if you might become positive. You could explain all this to the clinic when you next need PEP.
There is little risk form a single dose of Truvada
An important caveat is that advocates at i-Base are not doctors. This practical information is just based on the theoretical mechanism for PEP and the difficulties in accessing PEP promptly.
Please see this link for more information about PEP:
https://i-base.info/qa/factsheets/pep-faq
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https://i-base.info/feedback
Hi Listen, a viral load of 124 means that HIV cannot be passed on sexually. Have you heard of U=U? It means that when you are undetectable (viral load below 200) that you are also untransmissable – you cannot pass on HIV via sex: https://i-base.info/u-equals-u/ The side effects don’t mean that this medication is working better than if you were to have none. The side effects just mean this is how your body tolerates this medication. As your girlfriends viral load is below 200, there is no need for you to be on PEP. You are not at risk.
Hi I’m Theo I had sex with my partner , while using a protection but unfortunately the condom burst while we’re still busy, I then Found a report on her phone that shows that she’s HIV and she started her treatment on 2019 but her virial load of HIV was still low in 2020, it was 124 virial load.
I started taking pics 2days before the incidence, and after a day of taking the medication , I started to develop some ulcers in my mouth, light headche, loss of appetite, vomiting, muscles inches and lost of food taste, and the smell of pep treatment it affected me so badly , it sometimes makes me to feel dizzy.
I went back to the clinic and consult with a male clinician that gave me the medication and he told me that those are signs of showing that the medication was really working in my body.
Now I’m on day 5 of taking my medication, will I be HIV if I stop taking the medication
Hi Leo, if you stop PEP early it is less likely to work. As such it would not be recommended to do what you are suggesting, especially at day 21. Stopping at day 26, like as suggested in the post above is not likely to cause harm and does have some benefit. Have you considered PrEP? On-demand dosing does not require regular medication and when used can prevent need for PEP. This link will explain more: https://i-base.info/guides/prep/on-demand
Hi I am on 28 days of pep and am seeking advice on if it is okay to stop on day 21 or 26 to save some pills in case I ever need them again ( it was very hard and long to get this prescription)
Hi Adrian, regardless of the combination, you have started PEP within 72 hours. PEP will have the same potency. It is best now not to switch back and remain on your current regimen for the remainder the course. Are you doing better on this combination?
Hello, I had a possible high risk exposure and got pep within 12 hours but after 2days of consumption, I could no longer put up with the side effect of the medication I was given which was viraday. I went back to the same clinic and they prescribed me tenof-em and tivicay. I’m still well within the 72 hours period from exposure. Will switching meds now affect the potency of pep? Should I switch or remain on the previous drug and soldier on the side effects.
Hi John, thanks, there are no problems taking PEP and COVID-19 vaccines at the same time. The caution is only about supplements, not foods that contain aluminium and magnesium. This is becasue supplements reach much higher levels.
Hi,
I started PEP 2 days ago, 7 hours after possible exposure, I’m due to have my 2nd dose of the covid vaccine in a few days and wanted to know if the 2 will affect each other in any way?
I haven’t seen any studies on this, also I see on the label of Raltegravir that Aluminium and Magnesium containing antacids shouldn’t be taken within 6 hours but what about foods containing high amounts of magnesium and aluminium like nuts, milk, etc and protein supplements like Whey. Do these affect the results of PEP or is it only antacids not any food?
Hi Mila, you don’t say which country you are in. This might be important for advice about what to do now. Please contact the doctor that prescribed the PEP to talk about your response so far. They can also monitor and access the problems you report. They can also evaluate the risk with you of different options.
Hello I’m a health care worker and had a needle prik injury at work (the patients hiv status is unknown)
I’ve been taking pep for 2 weeks now and it’s not been an easy journey.
Lately I have been having kidney pain and it’s persistent through out the day- I know that pep can cause kidney impairment and was wondering if I should stop taking the medication as to preserve the health of my kidneys or I should continue?