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How long after exposure?
Oct 17, 2000

I know I can get a lot of flak for this, but I need to ask the question and be honest about it. My lover is negative, I am positive. We do not use protection during sex. I am undetectable (using ultra-sens test), and I have a T-Cell count of 897. I'm extremely healthy and am the "bottom" in the relationship. He knows about my status and we have talked openly and honestly about this. It was his decision in the end to have sex the way he wanted. Yet I told him, I wanted him to be tested every six months. He is still negative, and we've been together over 3 years now. But none of the above is the real issue. If he ever does start to sero-convert, how long after can he go on the HAART to stop the HIV from taking hold in his system? I'm not very aware of the current research on this subject. For myself, when I sero-converted, I got pretty sick for 2 weeks. I had over 103 temperature for a week during that time. Sweating all the time, I wasn't throwing up, and I can't recall ever having the flu, but I seemed like that was what I was going through. I just felt awful. If during this tell-tale time I had gone on the HAART, could I have stopped the virus? What I'm really after here I guess, is if my lover goes through these same signs and starts getting sick like that, can the immediate use of HAART during this time stop it?

Response from Mr. Kull

I'm glad that you asked this question. A lot of people in your situation don't speak openly because they are so used to getting "flak." It takes a lot of courage to send in a question like yours, even when it is anonymous.

First let me refer you to several previous responses that are quite relevant to your situation: Serodiscordant male couple anal sex, Women's risk of transmission... (contains info on viral load and transmission), Wondering about PEP, and Likelihood of converting from HIV- to HIV+.

You'll see in those responses that your boyfriend is at lower risk than if he were the bottom and if your viral load were higher. This may be why your boyfriend has not been infected yet. Or it could just be luck. Probability dictates that the more you and your boyfriend have unprotected sex, the greater the chances are of him getting infected at any given time. Right now it seems like you are relying on things staying the same.

You probably could not have "stopped" the virus if you had started taking medication when you were showing the flu-like symptoms typical of the acute retroviral syndrome (ARS). While it is now believed that taking medication during that period might help some individuals maintain a lower viral set-point throughout infection, it is too late for post-exposure prophylaxis (PEP). PEP is probably only effective in "stopping" the virus if taken within 72 hours of exposure, potentially keeping someone HIV negative. If you continue having unprotected sex with your boyfriend, it seems the only option for him would be to take medication when he manifested ARS symptoms. It is unrealistic for him to take medication every time you have unprotected sex. Talk to an HIV specialist about your situation so you can plan ahead and know your options.

It is important to recognize how you share the responsibility for safer sex with your boyfriend. You state, "It was his decision in the end to have sex the way he wanted." That's true, but only partly. You are also making a decision to have sex the way he wants. You don't HAVE to let him fuck you without a condom. Denying your own responsibility might temporarily help relieve some anxiety you have about the situation. It would be potentially devastating to you, your boyfriend, and your relationship if your boyfriend became HIV infected.

My intent is not to make you feel bad or guilty. I'd like to tell you guys to use condoms all of the time, but I understand that it is not that easy. Of course you want the intimacy and closeness that barebacking offers, a desire can sometimes override the fear of infection. But let me make one last suggestion: try not to act on the frustration of HIV infection by tossing away the condoms altogether. Try dealing with the frustration in other ways, like talking with others in your situation.

Best --

RMK



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