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Potential Exposure 8 Hours Ago - PEP??
Jul 20, 2009

Dear Doctors,

I'm rather worried about a potential HIV exposure that occurred roughly 8 hours ago with someone I met online. I was the receptive (male) partner, and found that the condom we used broke, and therefore that I had unknowingly had his semen in me for roughly a minute or so.

Once I realized this, I immediately attempted to remove any semen present, and checked for any signs of blood (thankfully, there were none). Shortly thereafter, I also washed as best I could (inside) with soapy water, followed by some antimicrobial wipes, and then a coating of Neosporin. (I realize that may not have any effect, but I assumed it couldn't hurt)

Though I have no evidence saying he's HIV+ and he told me he is not, I am still worried. I know I'd be within the PEP time window, but I'm not sure what to do. Do you believe it would be indicated in my case? If so, what type would be the best given the situation? Also, since I don't currently have health insurance, do you have any advice as to where I should seek treatment? Finally, Is there anything I can be doing in the meantime to lessen the risk?

Please help me - I don't know how to weigh the risk. Thank you so much for your help....

Response from Dr. McGowan

PEP should be used if there was a potential exposure to HIV. The risks and benefits must be weighed. Generally, I would recommend prophylaxis in the setting your described. Treatment should start as soon as possible after the exposure (preferably within 4 hours)but may be started anytime within 48 hours. In your case, the best thing would be to go to your local emergency room.

Many of the drug companies that make antiretroviral therapies have programs to make them available for people who have been exposed to HIV who do not have insurance. For example Gilead (maker of Viread and Truvada, commonly used in PEP) has a number through their Patient Assistance Program: 800-226-2056. GSK (which makes Combivir, also used in PEP) has a patient assistance number: 1-866-PATIENT.

Best,

Joe



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