[Question #8871] Second exposure on PEP

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38 months ago
Sorry to be back so soon but I do have one more valid question 

If my PEP regimen is 30 days long, but I got potentially reexposed on the third day (before my first dose of the day) essentially leaving a time line of 
Exposure > 2 full days of PEP > 2nd exposure > 28 full days of PEP (30 days of PEP in total) would that affect the effectiveness of PEP for the first exposure? Or because the exposures were within 72 hours would the PEP remain equally effective? 

If it’s too confusing I can try to reexplain it 
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Edward W. Hook M.D.
38 months ago
Welcome back to the forum. I am surprised you didn’t mention your second exposure in your initial post.

If you were taking PEP at the time of a second exposure two or three days following your initial, possible unprotected exposure, the antiviral medication that you were taking as PEP would be active and prevent infection. There would be no need to change the duration for which you are taking PEP and no change in the effectiveness of your PEP for prevention of infection from the initial exposure.  EWH 
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38 months ago
Thank you and does throwing up while on the duration of PEP affect the efficiency or count as a missed dose? The first week I felt very nauseous and gagged (don’t think there was any throw up) and I feel better now but nausea still comes rarely. 
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Edward W. Hook M.D.
38 months ago
We’re you to throw up within an hour of taking your medication there is no assurance that enough drug was absorbed to count as a full dose,  after an hour, the drugs fully absorbed. EWH ---
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38 months ago
Thank you Doctor. 

Would one missed dose make PEP ineffective? Would I be better off stopping PEP now or would completion of all other 59 doses still reduce my risk of infection significantly? 

What would the risk of infection be for vaginal penetration with one missed dose of pep? 


And that’ll be my last question. Sorry that they kept coming, but my anxiety and OCD keep messing with me and creating new scenarios that would make it so this exposure infected me. That’s why I’m know concerned that what I once thought was a gag was now a vomiting incident. I know that’s not your guy’s domain (anxiety) so that’s why I promise I wont buy further questions. Thank you for the help regardless. 
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Edward W. Hook M.D.
38 months ago
No, missing a single dose of PEP would not necessarily make the total course of therapy ineffective.  There are no statistics on how missing a single dose of pep would modify the risk for acquisition of HIV.

I’m sorry you struggle with OCD and anxiety. I urge you to seek professional help for this if you are not already as this is clearly impacting you.  

As you mentioned, this thread will be closed shortly after this response. Take care. EWH


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38 months ago
Sorry but one of the questions was also after missing a single dose would you recommend I continue with PEP or stopping? Or would you stop or continue?
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Edward W. Hook M.D.
38 months ago
As I said in my initial response, I would not have recommended PEP at all in your situation.  The decision to take PEP is an individual one.  So is the decision to continue. EWH ---
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38 months ago
Ok but would it be worth it to continue even with a missed dose? I know there’s no exact percentage but is it pointless to continue after having missed a dose or would it still provide some reduction on risk? 
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Edward W. Hook M.D.
38 months ago
This has been addressed.  You are far past your allotted three questions. EWH ---