Of HIV PEP Symptoms and Side Effects

Posted on October 29, 2014 by drtan

Mr. J was a young easy going chap. He had a high flying job and had made his money. He therefore decided to pursue his dream of seeing the world with his bicycle. He took a year off from work, packed his bike and started on his journey. He visited many beautiful cities, seen great natural wonders and generally had a great time. He then made his way over toThailand. That was when this story really starts.


Mr. J does not describe himself as gay or homosexual or a more medically technical term: a man who has sex with other men. However, on one night inThailand, he met S. They met in a bar and hit if off immediately. Outwardly, S looked very much like a woman. It was only after they got back to his room and undressed that Mr. J realised S was actually a man. Perhaps it was the alcohol, perhaps it was the moon, Mr. J did not really know. But whatever it was, Mr. J proceeded to have sex with S. Mr. J even allowing S to insert his penis into his anus.


After it was over, Mr. J started to worry. He asked S over and over again if he had any illnesses. S tried to reassure Mr. J but he would have none of it. The very next day, he grabbed his bike and got on a plane toSingapore.


He landed in the afternoon and came straight to my clinic. When I saw Mr. J it was obvious there were 2 things eating at him. First was the fear of HIV. But what I thought was affecting him even more was that he could not believe he allowed himself to do what he did. I tried my best to advise him not to judge himself so harshly and focus on HIV prevention. But I could see that little of what I was saying was getting through.


In terms of HIV risk, well, as much as both Mr. J and I wanted to believe S that he was clear of all infection, we just had to assume the worst. The fact is there was a study that estimated the prevalence of HIV amongst trans-sexual sex workers inBangkokto be as high as 49%! Also, unprotected receptive anal sex is probably the highest risk sex act for contracting HIV. It was therefore an easy decision to start Mr. J on PEP.


A baseline HIV antibody test was done which was negative. I took his blood for liver and kidney tests and started him on Truvada and Isentress.


By that time, Mr. J had just about enough of his bicycle adventure and decided to go back home. Not long after arriving back in his home country, he started to develop a high fever and severe sore throat. He was literally bed ridden. This was at day 5 post exposure.


Not surprisingly, Mr. J was in a state of panic. Was it HIV ARS? Was it a side effect of the PEP? When he contacted me, I re-assured him that it was neither. HIV ARS does not happen at 5 days post exposure and the medicines we gave him for PEP do not cause such side effects. I advised him to see his local doctor as I suspected he had some kind of throat infection maybe even a tonsillitis.


Mr. J dutifully saw his local doctor who diagnosed a bacterial tonsillitis and gave him some amoxicillin. But horror of horrors, the next day Mr. J developed a red rash all over his body!


By that time, he was in such a state of panic. He could not eat, could not sleep and was starting to lose weight. Despite repeated reassurances that what he had could not be HIV ARS, Mr. J was unconvinced. In fact, he was so convinced that he was already infected with HIV, he decided to stop his PEP medicines. Fortunately, I managed to convince him to start taking the medicines again and he only missed 1 dose.


Over the next 3 days, he started to feel better. The fever subsided and so did all the other symptoms. The rash took a little more than a week to go away. His local doctor saw him again and made the diagnosis of a viral throat infection with a rash caused by the amoxicillin.


Still, Mr. J lived in abject fear for the next few weeks. Finally, the day of truth came. The day that he finished his PEP medicines, he flew all the way back toSingaporeto see me. Even I felt some palpitations as we watched the HIV test run. 1 minutes, 2 minutes slowly ticked by. Finally, the result was obvious. He did not have HIV.


2 months later, Mr. J tested for HIV again and was still negative. Mr. J had a hard time letting go and accepting this fact. He continued to test for HIV multiple times over a few months. Finally, he is beginning to come to terms with the fact that he does not have HIV. Still, every time he get s a fever, he feels a very familiar fear creep up his spine.