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TIME SENSATIVE-Exposed 2 Days Ago
Sep 15, 2003

I'll try and make this long story short. I was with an individual two nights ago whom I found out was HIV+ the next day. I have talked with my doctor and concluded the following information. We had unprotected anal sex (me receiving) for a brief period of a few minutes. The HIV+ person is on meds and had an undectable viral load and a T-Cell count in the 400's. My doctor has indicated that he can do an immediate test approximately on week after exposure and have the results in a week. The other possibility is to go on Epivir and Viread for a period of 30 days. My doctor has indicated that this would significantly reduce my chances of permenant infection but he thinks my risk of exposure given the circumstances is fairly minimal but not impossible. Thoughts? And thanks for your great work.

Response from Dr. Frascino

Hi,

Unprotected anal receptive sex does place you at some risk for STD's, including HIV. If your partner ejaculated into you, your risk increases up to 3 percent, according to the best studies we have. Since your partner's viral load was undetectable, that decreases your risk somewhat, but not entirely. PEP (post-exposure prophylaxis) should be started as soon as possible after an exposure, and no later than 72 hours to have the best chance of working. However, even when started within the 72 hour time frame PEP does not always protect against HIV transmission. I, for instance, started my PEP within minutes of my exposure in 1991, and still seroconverted.

Regarding the best choice of medications for PEP, if you know what medication your partner is taking (and has taken in the past), this might influence which medications would have the best chance of working for you. For instance, if you know your partner had been on 3TC (Epivir) in the past and became resistant to it (by getting an M184 resistance mutation), then this drug would not be the best option for you.

Should you take PEP? Only you can decide. Your risk at least warrants serious consideration, even though the odds are still very much in your favor for not having contracted the virus. Good luck with whatever decision you make.

Dr. Bob



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