Is it normal to feel fever and chills one day after starting Post-Exposure Prophylaxis (PEP)?

Fever and Chills After Starting HIV Post-Exposure Prophylaxis (PEP)

Yes, fever and chills are normal side effects that can occur one day after starting PEP medications. These symptoms are commonly reported reactions to antiretroviral medications used in post-exposure prophylaxis regimens.

Common Side Effects of PEP

• Fever, chills, rash, myalgia (muscle pain), fatigue, malaise, and lymphadenopathy are frequently reported symptoms that may occur shortly after starting PEP medications 1
• These symptoms can be similar to those of acute HIV infection but are often due to drug reactions rather than infection 1
• Side effects typically begin within the first few days of treatment and may resolve as your body adjusts to the medication 1

Managing PEP Side Effects

• Most side effects of PEP medications can be managed without changing the regimen by using supportive medications that target specific symptoms 1
• For fever and chills specifically, over-the-counter antipyretics may provide relief while continuing the PEP regimen 1
• Modifying the dose interval (taking smaller doses more frequently throughout the day as recommended by the manufacturer) may help reduce side effects while maintaining adherence 1

When to Seek Medical Attention

• While fever and chills are common side effects, you should seek medical evaluation if:
  • Symptoms are severe or worsening 1
  • You develop additional concerning symptoms such as severe rash, difficulty breathing, or signs of dehydration 1
  • Symptoms persist beyond 3-5 days without improvement 1

Importance of Completing PEP

• Despite experiencing side effects, completing the full 28-day PEP regimen is crucial for maximum effectiveness in preventing HIV infection 1
• HCWs (and other PEP recipients) who fail to complete the recommended regimen often do so because of side effects, but discontinuing treatment early significantly reduces protection 1
• Adherence to the complete course is essential - taking antiretroviral medication 1-2 days late can still maintain effectiveness, but developing a pattern of missed doses significantly increases the risk of treatment failure 2

Follow-up and Monitoring

• If you're taking PEP, drug-toxicity monitoring should be performed at baseline and again 2 weeks after starting PEP 1
• This monitoring typically includes a complete blood count and renal and hepatic function tests 1
• Regular follow-up allows healthcare providers to assess side effects and make appropriate adjustments to manage symptoms while maintaining the effectiveness of the regimen 1

Remember that while experiencing fever and chills can be uncomfortable, these symptoms generally do not indicate a serious problem and should not be a reason to discontinue this potentially life-saving treatment. Always consult with your healthcare provider about any concerning symptoms rather than stopping medication on your own.