Yesterday, October 8th, was my last day of post-exposure prophylaxis. In truth, it was not as bad as I was expecting it to be, but man, those 30 days were a roller coaster of (predicable) side effects. According to the Combivir informational booklet, about 9% percent of patients experience malaise/fatigue, which I definitely did. About halfway through the treatment, I got so down and tired that I actually called my PCMO to ask if I was experiencing this depression and exhaustion as a consequence of the medicine, or if something else was going on with me. Long story short, after the discussion with the PCMO, we (the PCMO and I) came to the conclusion that I was pushing myself too hard on a medicine that was really hard on my body, and, as such, was feeling much more exhausted and frustrated than usual. She was right, of course- I did not reduce my work load when taking these meds, even though I was really tired much more often, and definitely felt frustrated at my inability to function fully.
The cycle of side effects went something like this:
One to two weeks of nausea, with incidents of nausea decreasing over the month. However, throughout the entire 30 days, I did occasionally have spontaneous vomiting, which was really strange and something I have never experienced in my life. One minute I would be finishing up my breakfast, getting ready for work... two seconds later, I would be vomiting in the sink. This apparently is a pretty common side effect (up to 13% experience vomiting as a side effect). I am usually not someone that vomits easily, so that was very strange for me.
Two to three weeks of general fatigue. I spent a few days so completely worn out that I literally slept 18 hours a day.
Three weeks of feeling slightly off. In general, the Peace Corps makes a person feel a little off- one's emotions are exaggerated, highs are higher and lows are lower. For the past few weeks, I felt blunted. I found that my normal coping mechanisms did not work as well. Usually, during my emotional highs, during good language days, or during good transport days, I feel proud, confident, and inspired. During my emotional highs while dealing with the fatigue associated with Combivir, I felt just happy to get through the day.
Your body eventually adjusts to the side effects of taking this medicine; However, I was/am in the position that I am not taking the medicine long enough for my body to fully adjust to the long-term presence of combivir in my body. Thus I took it long enough to feel the side effects, but not long-enough to know what it's like to be on the medicine for extended periods of time. I feel that I can better relate to future patients or peers that are taking Combivir for HIV, especially if they, too, suffer from side effects similar to mine. However, I will have difficulty relating to patients or peers that are on this medicine long term. Currently, combivir is listed as an "alternative" for HIV treatment, and usually in combination with an additional medication.
In short, these past 30 days have been interesting for me. Even AIDS.gov (wait, that's a real website? Oh.... yes it is) says that PEP can have side effects that make completing treatment difficult, and I definitely understand why some people stop treatment.
Just for future reference: Post-exposure prophylaxis IS available in the United States, and can be accessed by anyone who suspects exposure to HIV. So if you come in contact with a dirty needle, have risky sex, experience condom breakage, were raped, or exposed to any of the bodily fluids which may transmit HIV (that's semen, blood, vaginal fluid, and breast milk) and are not confident in the sero-status of all parties involved, you may chose the option of taking PEP. Talk to your doctor, gynecologist, or head down to the local ER within 24 hours of exposure. Remember, PEP is most effective if taken within 72 hours of exposure to HIV, so do not hesitate to pick up some PEP if you feel you have been exposed to HIV.
