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Are repeated PEP regimens effective over time?
Aug 7, 2009

I've been unfortunate enough to have been the receiver of deep anal unprotected sex from 3 HIV positive men over a 3 year period, all who claimed they were negative. In each case the sex involved ejaculation deep inside me and rectal tears and bleeding were present. After the encounters, they agreed to visit the local HIV test center the next day or two to check status and have inidcated positive. I then start a 28 day regimen of Truvada and Kaletra, and in all 3 cases have stayed negative. I just had a 4th such encounter and started the regimen 8/4/09 and an wondering if the drugs lose their effectiveness over time with repeated use. The ecounter prior to this one was 3/13/09 and I tested negative on 8/4/09. Also, since I know I have a problem with saying no to unprotected sex, might you have any advice for an effective way to change this insanely dangerous behaviour?

Response from Dr. Young

Hello and thanks for your post.

Yes, repeated PEP regimens should retain effectiveness.

I would remind you to continue to get your follow up HIV testing, to be sure that things worked as expected.

As for the "insanity"; a few suggestions. In general, harm reduction tries to identify the circumstances that place you at risk and to decrease the risky behaviors (even if not eliminating them). For example, are drugs or alcohol involved? How is disclosure of HIV status discussed (if at all)? If condoms are not available, how about lubricant? Last, it seems apparent that you're aware of some of the risks, but really, unprotected anal receptive intercourse with multiple partners puts you at one of the highest risk categories for getting HIV. Think twice before crossing this road.

And, be well.

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