PEP in practice

• PEP in practice
  28 year old lab technical got needle prick injury during sample collection attended for PEP in a teaching institution advised AZT+3TC+EFV, after the second day that client experienced confusion, abdominal pain, vomiting. Symptomatic management and counseling given by ART medical officer and advised to change regimen if the symptoms persist. But by day 12 DNA PCR done with negative PCR report PEP stopped.
  Is it wise to do like that?
  -NO!!
  -Change regime AZT to STV
  -Take EFV in empty stomach or in divided doses
  -At least ask to continue STV+LMV for 28 days
  
  Reasons:-
  · Any investigation can give false positive and false negative results-Not only PCR
  · Most of the reported studies with PCR and PEP not from our country, not from this virus subtype.
  · Even with PEP failure case slow progression was reported
  · Even with PEP failure case latency will be reduced which may be important in future if cure is available
  · Even with PEP failure case low viral load during window period might reduce transmission in case of unprotected sexual intercourse.
  · Too short duration of therapy might result in resistance to the future first line regime.


• My experiances with PEP

PEP for 2days, 7days, 14days and 6months(none of the guidelines about PEP in this world is supporing this commision of negligence).

Nevirapine as a PEP regime by OG post graduates(May get SJS).

PEP after 5 days of needle prick(More prone for resistant strain.