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always played safe bu now riddled with anxiety, Help!
Nov 7, 2003

This is my fifth try, so I hope that you will answer this time, as my anxiety level is getting really bad! I promise a donation will be in the mail! I had possible receptive anal exposure when a condom broke, but the guy had not ejaculated. I noticed two condom packages the next morning, but only the one broken condom. Unfortunately, I was not aware of the guy's HIV status, so insisted on starting PEP within 61 hours of this incident. I am taking PEP for 2 days. My baseline PCR DNA viral tests (3 different types), within 62 hours, were normal, and I had tested negative on the Home Access antibody test two days prior to the incident. How often does PEP work? I plan to take the antibody test again at 25 days, when, on average, 50 or more are accurate, then again at two and three months. Shoud I consider the PCR DNA tests as being encouraging? Will the PEP impact my future antibodies tests? Can I shout a little whoooey-hoo or whatever after 25 days? What are my chances? I always played safe, but now I am riddled with anxiety. Please help!

Response from Dr. Frascino

Hello Riddled with Anxiety,

The good news is that you have "always played safe" and have multiple baseline negative HIV tests. By the way, why did you have so many? You had a negative Home Access antibody test 2 days prior to your potential exposure. That single test confirmed your negative baseline status and is all that you needed. A negative PCR is always encouraging, but getting 3 different types of PCR DNA tests within 62 hours is unnecessary, unwarranted, and not at all helpful.

The not-so-good news is your "possible receptive anal exposure" due to a broken condom. On the upside is:

1.Ejaculation did not occur.

2.Your partner's status is unknown (rather than confirmed positive).

3.You started PEP within 72 hours.

How often does PEP work? We don't have an answer for that, because the way we prescribe PEP and the medications we use are different than those used in the original studies. We can say that it does increase your chances of preventing an infection following an exposure.

What to do next? I would not advise or recommend any additional HIV testing until 3 months, unless you develop symptoms consistent with ARS, at which time a PCR might be helpful.

What are your chances? Actually very, very good. Remember the probability of HIV transmission from one HIV exposure of receptive anal sex with a partner confirmed to be HIV-positive is estimated to be 0.1 3 percent. Your estimated risk is less, because your partner's status is unknown.

Can you "whooey-hoo or whatever" after 25 days? No, I'd save the celebrating until your 3-month negative ELISA test. Write back and share that good news with us, OK? We are all sending you loads of good karma and good luck.

Continue to "always play safe" and follow the guidelines for PEP, if and when accidents occur. You've done everything you can to protect your negative status. The odds are very much in your favor. Good luck!

Dr. Bob



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