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Risk Evaluation

Sep 30, 2009

I was having unprotected anal sex with my partner. I am HIV+ with an undetectable viral load for 3 years and take my medication with 100% adherence. He is the insertive partner and noticed a skin abrasion (the skin is not broken, but it's inflamed). Apparently, I bled a little. I was wondering what the risk level is? Is PEP appropriate?

Response from Dr. Frascino


Unprotected anal sex, with or without the skin abrasion and bleeding, would be a significant risk for your HIV-negative partner. The abrasion and bleeding further increase that already significant risk. Yes, PEP would be warranted and should have been started as soon as possible after the exposure.

It is true that being on effective combination antiretroviral therapy that has driven your HIV plasma viral load to undetectable levels significantly decreases the chances for HIV transmission; however, it does not eliminate them. Your partner is playing a very dangerous game of sexual Russian roulette every time he chooses to have unprotected sex with you. You are also knowingly putting him at considerable risk. Why?

I would suggest you and your partner review the information in the archives of this forum devoted to magnetic couples. Pay particular attention to the harm-reduction strategies for magnetic couples. PEP or no PEP (it needs to be started within 72 hours of the exposure), your partner needs HIV testing now and at the three- and six-month marks, assuming both you and he stop putting him at risk.

Dr. Bob

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