Question
Will PEP still work with resistant HIV?
26 April 2023. Related: Access to treatment, Adherence, All topics, PEP/PEPSE, Resistance.
PEP and HIV resistance.
HIV in my country has more than 10% of resistance to tenofovir and lamivudine, a high number, according to WHO, but the PEP offered here has dolutegravir, tenofovir and lamivudine.
Is dolutegravir enough to prevent the HIV infection through PEP if the virus that I was exposed to is resistant to tenofovir and lamivudine?
And if this is the first line treatment, what will happen if this treatment fails? A treatment with second or even third line drugs?
Answer
Hi, how are you doing?
10% is a high level of resistance. But it still means that 90% of HIV in Brazil is not resistant.
This 10% is also not resistant to dolutegravir. This is why triple combination drugs are used. Even in the case of resistance to tenofovir and lamviduine, the presence of dolutegravir will allow PEP to continue to work.
PEP is given on the basis of what is available in the country and the cost of treatment. TLD is first line as it is easily accessible and is not en expensive treatment. The most common reasons for PEP to fail is people not taking it properly or stop the course early. It is rarely because HIV is resistant to all drugs used within the PEP combination.
If using TLD as PEP was to fail and resistance testing was done to check that it is because of a resistant strain. Second and third line combinations can be used to treat HIV. Again this is based on WHO guidelines but is determined by what the country has access to.
Josh.
Hi Riri, yes PEP will still be effective. PEP is recommended if it can be accessed and started within 72 hours of an exposure.
Missing one dose of PEP is unlikely to change how effective PEP is over the duration of the course. It is recommended that if you vomit within 2 hours of taking meds you take a second pill. This being the case, it is okay to miss a dose and it still work. You do not need to panic.
More information about PEP can be found here: https://i-base.info/qa/factsheets/pep-faq
Hi, I was exposed to HIV and only knew at the 60th hour. Will PEP still be effective ? I was given TLD. On the 13 day I vomited five minutes after taking it because I poked my self with a toothbrush accidentally but not sure if the pill came out or not. I didn’t take a second dose coz I was not sure. Took my 14th dose the next day same time. I am now panicking
Hi Nick, yes your wife and baby are safe. As you are on PEP any presence of HIV will be suppressed and prevent any risk of transmission.
When PEP finishes and you are waiting to test (a minimum of 6 weeks) it is advised to avoid sex as you are unsure of your own status. You can have sex using a condom but will need to ensure it does not burt to preent any risk to your wife and/or baby.
More information about PEP can be found here: https://i-base.info/qa/factsheets/pep-faq
WILL PEP PROTECT ME AND MY PREGNANT WIFE?
Greetings.
Hope you are well and I am humbled by the information you have provided on the website in regards to health living.
I am from Uganda and I am taking PEP including a combination of TDF and other drugs. I have so far taken it for 13 days now and I recently had protected sex with my pregnant wife and unfortunately the condom burst and broke. I managed to realise it and I withdrew and poured the semen outside.
Is she and the baby safe since from the earlier test, we both tested negative.
Hi Raja, PEP will still work if you have other infections present. Is there a reason you are not on treatment for the other infections?
More information about PEP can be found here: https://i-base.info/qa/factsheets/pep-faq
Sir I have other STD I know that but after exposure I started pep within 24 hrs but I don’t take any medication for other STD before so pep will work or not work because of these underlying std
Hi Tim, when taken within 72 hours PEP is ~80% effective. This number changes on the absolute risk of the exposure and how well PEP is taken. In practise more than 80% of treatments with PEP will be effective.
PEP: https://i-base.info/qa/factsheets/pep-faq
Success of pep medication at 68 -70 hours of exposure ? What is the success percentage
Hi Urban, TLD is not PrEP. It is PEP. PrEP only uses 2 drugs and this is a combination of 3 drugs.
TLD: https://i-base.info/guides/14970
I am taking a PEP tablet with letters “LTD”. One of my friends when he looked at the tablet, he said it is Prep. Can Prep have letters LTD written on the tablet?