#1---"even though I'm off the PEP medicine for 3 days now I should finish the rest of the meds anyway? (Like I mention earlier, I have 7 more days of the medicine left."
Yes. You should resume taking the rest of your 7 days of medication. Even though you missed 3 days you will benefit from the prophylactic effects of taking all of them because you have a low risk of having contracted HIV. Think of it like this: let's say you have a very low chance of getting HIV from your brief exposure, would you suffer through taking the medication for 7 additional days if you knew "for a fact" that some HIV virus from your HIV+ partner entered your bloodstream from your open area on your gums? Suffering through 7 days of PEP therapy is a lot different than receiving a diagnosis of having AIDS. HIV virus multiply rapidly. You are very wise to take PEP. Kudos! You may have saved your life. There is an old saying: "An ounce of prevention, is worth a pound of cure". In the case of preventing HIV infection, I will say, an ounce of prevention, is worth a TON of cure.
The PEP medications are necessary to prevent any virus from replicating in your blood. You want to build a viral "barricade", so to speak, so that any HIV that might have entered your blood stream through your open area on your gums cannot replicate (enter your blood cells and then multiply). HIV begins its infection by binding to the CD4 receptors on the surface of the host's lymphocytes (part of the white blood cells) which are part of the host's immune system. After the virus joins with the host cell, HIV enters inside the cell---this is what you must prevent by continuing the PEP medicines.
Once the HIV enters a host's (a person exposed to the virus) cells then the HIV genetic material (RNA) is released into the host and undergoes reverse transcription into DNA. An enzyme in HIV called reverse transcriptase catalyzes (assists) this conversion of viral RNA into DNA. Also, viral proteins (HIV protease) process other HIV proteins; therefore, protease inhibitors anti-viral medications which you are taking Crixivan, act by blocking this maturation step of the HIV virus. Unless the HIV lifecycle is interrupted by PEP, the virus infection can get a foot-hold and will rapidly spread throughout your body which will eventually result in the destruction of your immune system. However, since you have previously taken an appropriate reverse transcriptase inhibitor Combivir and a protease inhibitor Crixivan, then no HIV will be able to bind to your CD4 receptors. This is why it is very important for you to complete all of the PEP medication.
#2---"What do you mean by system clearance of the medicine? and the plasma half life? Is that why I feel much better after I stopped the medicine just for 1 day?"
Systemic clearance of PEP medications is rapid which means that the medications are broken-down rapidly into various microscopic particles (molecules) which are then rapidly metabolized by your various body systems e.g. your kidneys, your liver, your lungs, your gastro-intestinal system, etc. and then these metabolites are excreted in your urine, feces, and exhaled gases when you breathe (however, this is usually a very miniscule amount).
The time taken for the plasma concentration of the PEP medications to be reduced to half of their original strength is called their "half life". The half life of the medications is considered in relation to the amount in your blood plasma. Therefore, it is called "plasma half life". A medication's plasma half-life depends on how quickly the molecule (the tiny particle that's left after the medication is metabolized) is eliminated from the plasma into the excretory system (kidneys, GI system, liver, lungs). The removal of a medication's molecules from the plasma is "clearance" and the medication molecules that move into body tissues is called "volume of distribution". So that clearance and volume of distribution of a medication are important when the drug manufacturers determine a medication's serum half life.
The concentration of a medication will reach a peak value in the plasma and then it will decrease as the medication is broken down into molecules and finally cleared from your bloodstream into the urine.
Pharmacokinetic Parameters for Combivir (lamivudine combined with zidovudine):
Systemic clearance (L/hr/kg) for lamivudine = 0.33 +/- 0.06 n = 20 for zidovudine = 1.6 +/- 0.6 n = 6
Renal clearance (L/hr/kg) for lamivudine = 0.22 +/- 0.06 n = 20 for zidovudine = 0.34 +/- 0.05 n = 9
Elimination half-life for Combivir: for lamivudine = 5 to 7 hours, and for zidovudine = 0.5 to 3 hours. So, you can easily see that if the two component drugs that make up the medication Combivir (lamivudine and zidovudine) are eliminated by one half in 7 hours (max) and then by another one half of that half in another 7 hours so that by 14 hours very little medication remains in the body, unless you have a problem eliminating the drugs e.g. liver damage or kidney damage.
Crixivan (indinavir) is also rapidly eliminated with a half-life of 1.8 +/- 0.4 hours (n=10).
#3---"Is that why I feel much better after I stopped the medicine just for 1 day?"
Side effects often occur after starting anti-HIV drugs but lessen or disappear after a few weeks. Other times they might last as long as that drug or combination is used. I cannot say for certain, if the reason you feel better is because you stopped taking the medicine just for 1 day (although this seems likely) or if it is because the medicines effectively cleared HIV or some other infection from your system. However, in general most people who take HIV medications suffer from nausea, vomiting, fatigue, diarrhea, headache, and other various maladies while they are taking the drugs; however, the alternative is much worse which is why most people continue with them in spite of their ill effects. Every anti-HIV drug has side effects. Some people experience more side effects than other people. It is dangerous to stop taking one drug (or all of the drugs) in your PEP regimen, reduce their doses, or decide only to take it periodically. This can cause drug resistance, making that drug useless for you to fight-off HIV. As long as you continue to follow your physician's prescribed regimen for taking the medications, you will avoid HIV infection. As I told you earlier, you can take the HIV PEP meds with an antiemetic drug at the same time.
#3---"Is the any OTC drugs I can get to help the nausea/weakness/fatigue while taking the medicine?"
Several OTC drugs are used as antiemetics e.g. Dramamine Original (dimenhydrinate),
Dramamine Less Drowsy (meclizine hydrochloride), and Benadryl which is the most commonly used anti-emetic drug available over-the-counter although drowsiness is a side effect of taking Benadryl. Kaopectate or Pepto-Bismol (bismuth subsalicylate) may also help treat nausea. It’s also used for upset stomach and as an anti-diarrheal.
#4---"In the event if I did unfortunately get infected,what's the next step?"
You have already performed the first and most important step, you are taking PEP medications. The next step is to be tested at the appropriate intervals as I have stated in my previous answer.
If you test positive then you are infected with the HIV virus and then you should take precautions so you do not spread the infection to your sexual partners or other people who might be at risk.
Having an HIV infection does not mean that you have AIDS. You should see your doctor so you can learn the status of your "viral load" and decide what therapy you need. Follow your physician's treatment plan because it will be specific to your particular case. Each HIV+ patient is different, each has different lab values. You will need to follow your specific treatment plan.
I also suggest to my patients, that they should follow a healthy lifestyle including
stopping smoking (tobacco, et al),
stop taking non-essential medications,
follow a healthy diet
http://www.mypyramid.gov/,
drink lots of fluids to flush the body's systems and to cleanse the body (at least 8 glasses or 1 1/2 liters of fluids per day),
get sufficient restorative sleep (at least 8 hours at night and take a noon nap) to restore the deficient immune system,
slow walk in fresh air for at least 30 minutes a day.
If you have an adequate level of hydration, a sound diet, adequate rest, and are not overly-stressed at an emotional, mental, or spiritual level then your body will produce an anabolic, or tissue-building/immune system-building rebound.
Edited by DrHanson on May 31 2006 at 3:06am__________________
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