Question
I was late and had unprotected sex while on PEP.
22 February 2023. Related: Adherence, All topics, HIV transmission, PEP/PEPSE.
I have been following this website for so long and appreciate all your help with people who need help like me. I am on the 28th day of my PEP course (Acriptega) and I would like to seek for your confirmation.
I took my first pills 24 hours after first exposure and kept adherence well until day 15. I accidentally took two pills 12 hours apart. I realised and went back to my normal schedule at 9am. On day 23 I was late by 3 hours and then had unprotected sex.
On day 24 I had unprotected sex again and was 9 hours late for the next pill.
On day 25 I lightly vomited after 1 and a half hours after taking PEP and I didn’t take another pill. Since then I have stuck well to timing.
I know I really messed up last week and I am scared now. Please advise if I am still safe and if I need to extend my course.
I am a man and had all exposure with women.
Thank you.
Answer
Hi, how are you doing?
No. You have not messed up how well PEP is going to work. As the doses you were late with were after day 21 there is going to be minimal impact, if any, on your treatment.
Taking 2 pills 12 hours apart on day 15 is going to have no effect.
The unprotected sexual encounters would have still been protected by the PEP in your body. PEP has a long half life – this means it can remain working in your body for a few more hours after the 24th hour.
Vomiting on day 25 an hour an a half later will not be a problem. At this point most, if not all the medication will be absorbed. There would have been no need to take an additional pill.
You do not need to extend the course of your current treatment. You can finish when originally planned.
Josh.
Hi Erick, the co-trimoxazole will not reduce how well TLD works. There is some evidence to show that co-trimoxazole can absorb how much lamivudine (the ‘L’ in TLD) is absorbed by the body. However this does not require dose adjustments and is not seen as a problem in people with healthy kidneys.
Even if you had known kidney problems, TLD is only a short course as is co-trimoxazole when using it for a UTI. This is not long enough to cause any problems. It is okay that you had taken these two medications together.
Hi Josh, Before my exposure to HIV i was on UTI dose co-trimaxazole. where i took co-trimaxazole 13minutes before Exposure to HIV, and i take PEP (TLD) like 18 minutes after Co-trimaxazole tabs 480mg, then after 12 hrs i took again 480mg of co-trimaxazole, then day 2 I take again 480mg of co-trimaxazole tables , after seven hrs I take my day 2 pep(TLD) , and stop on co-trimaxazole. and day 3 i took my PEP as normal until the end of my corse. will these Co- trimaxazole interact my TLD (PEP) ? Please tell me.