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Post exposure prophylaxis?
Jan 16, 2002

Yesterday I meet a guy at a party, we were both very drunk and ended up having sex. It all happened very quickly, I am HIV +ve (VL undetectable 5 yrs, CD4 800) but somehow I did not get a change to disclose my status to him. We didnt have any condoms so didnt do anal sex however, I did enter him for about 10 seconds, just entered him did not really move about much. I did not ejaculate and I dont think there was much pre cum. But I am worried that I may have infected him. I dont know his status but I think I should tell him that I am +ve so he can get tested. In the mean time what about post exposure prophylaxis? Would really appreciate some feedback.

Response from Mr. Kull

This sounds like a complicated situation for you, and it's encouraging that you are thinking about what happened and how you might proceed. Having TOTALLY safe sex is difficult regardless of your HIV status, and you took some steps to minimize your partner's exposure to HIV. The fact that you want to let your partner know about his risk for infection is not an easy task, but may be an important one.

The odds are against your partner being infected, for a few reasons. You inserted your penis into him very briefly and did not ejaculate. We do know that people can be and have been infected through pre-cum alone, so exposures like the one you describe should be minimized. However, ejaculation in the rectum greatly increases the risk of transmission.

There is growing evidence that a person with an undetectable viral load is less likely to sexually transmit HIV than a person who has a higher viral load. This does not mean you cannot transmit HIV to your sexual partners. Viral load can fluctuate, and viral load in plasma may not always correlate to viral load in semen.

All of this does not mean that your partner is not at risk for infection, so some steps should be taken. Your partner may be eligible for post-exposure prophylaxis (PEP), but that depends on a few things.

PEP--the use of anitviral medications shortly after a high-risk exposure to PREVENT infection--was initially used among healthcare workers who accidental needlestick injuries. Researchers found that PEP reduced the rate of infection by 79%, but some who took PEP still became infected. Research on PEP for sexual exposures is currently being conducted to see if treatments for the general public are feasible and effective.

Post-exposure prophylaxis probably needs to be started within 24-36 hours of exposure. Since the procedure is still not widely practiced, is expensive (and not covered by health insurance), and can cause troubling side-effects for people, PEP is only recommended for individuals who have a significant exposure to HIV. Criteria vary, but PEP is generally warranted when someone has unprotected vaginal or anal intercourse with an infected person or a person from a high-risk group, or for a victim of sexual assault. Programs that provide PEP are developing (mostly in urban areas) and hospitals sometimes have protocols for administering non-occupational PEP.

Strictly speaking, your partner does meet the criteria for PEP (some may require that there was ejaculation in the body) and he potentially was exposed to HIV infected pre-ejaculate. Besides the cost, hassle and side-effects of the medications, taking PEP should not have any long-term health consequences. Please read through the articles posted on the "Post-exposure Prevention for Sexual, Needle, or Non-occupational Exposures to HIV" page at The Body for more information(http://www.thebody.com/safesex/nonoccupational.html).

Good luck with this.

RMK



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