Questions from a pharmacist on PEP and choice of first ART?
1. What happens to the HIV that enters the cell after PEP is taken…..does it still circulate in the blood of the host and survives….is it possible that someone could be infectious after taking PEP, and after how many days does anybody become non-infectious after taking PEP.
2. while initiating ART, we usually recommend Atripla (TDF+FTC+EFV) as a first line med. but TDF is of high viral suppression power when compared to the other NRTIs…is it not possible some one started with Atripla, and develops resistance to it (due to adherence or any other reason) remains with out any other ART choices in the first line……could it be better if we start the patient with the other NRTIs and then move to Atripla when ever necessary?
Thanks for your questions, both good ones.
When PEP works, it stops HIV from replicating everywhere in the body. It either works or it doesn’t. HIV inside cells either dies if PEP is successful or survives if PEP doesn’t work
To see if PEP has worked, someone needs to wait 4 weeks after taking PEP before taking an HIV test. During this month anyone who has taken PEP should assume that they might be HIV positive.
For your second question, WHO guidelines are clear that Atripla or generic equivilents are still the leading first line treatment and that tenofovir DF should be included as a component of any first-line combination. It is better to use the best drugs first.
These two guide discuss first-line and second-line treatment.