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Post exposure prophylaxis
Nov 1, 2000

My sister was recently diagnosed with HIV. Her viral load was 115,000. Last time she and her boyfriend had intercourse was about a month ago (she says while she was having her period). He has tested negative for HIV. Should he consider taking PEP at this point? What else can he do to decrease his chance of getting HIV now (aside from safe sex/abstinence)?

Response from Mr. Kull

Post-exposure prophylaxis is probably only effective in preventing infection if medication is begun within seventy-two hours of exposure. It is possible for your sister's boyfriend to begin taking medication if he has been infected as an early intervention. PCR testing -- a blood test that detects HIV, not antibodies -- should indicate whether or not he has been infected one month after the exposure. There is some evidence that treating HIV infection before seroconversion may help a person's immune system keep better control over the virus over a longer period of time than someone who did not start medication early. These options should be discussed with an HIV specialist. See my response to How long after exposure? for more information on this topic.

Your sister and her boyfriend should do their best to use condoms for intercourse all of the time. If he decides to perform oral sex on her without a barrier (dental dam, plastic wrap), he should have good oral health and she should not be menstruating. I would encourage your sister and her boyfriend to get hooked up to a social support network that can provide them with the help they will need through this period. Call a local AIDS service organization for more information.

RMK



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