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A mad student
Jun 6, 2005

Dr.Frascino, as a med student, I could have a more honorable HIV exposure excuse but here it is: I somewhat engaged in unprotected oral sex with an anonymous guy. I do allow myself to take the risk but absolutely do not include ejaculation in that equation!

SO No. 1: I JUST HAVE TO SAY; IN TODAY'S WORLD, YOU GUYS ARE RUDE AND CRIMINAL TO COME IN PEOPLE'S MOUTH WITHOUT PULLING AWAY OR ANNOUNCING SO, I AM SO MAD!!!!!

No.2: My doc decided to put me on a post-exposure (40 hrs) prophylaxis of Combivir and Viracept for 14 days and then get tested. Now, I read that for sexual exposure, tx is usually 1 month...is that possible and can a test (even PCR) reveal anything after 14 days?? Shouldn't I do 1 month? I'm a little confused!

No 3. Also, isn't it logical to think that let's say I got infected, that PEP would delay immunologic response because of supression of viral load?? Hence my worries about obtaining a valid test that early (even though I understand tests are getting better at early detection)

Please, please, I respect your forum and really hope you can make sense of all of this...If I'm going to do this PEP thing, I want to do it the right way.

Many thanks

A mad & confused Med student

Response from Dr. Frascino

Hello Mad Med Stud,

1. First off, not everyone plays by the same rules when having sex. Consequently, you should make it absolutely clear to your tricks that you are not looking for a high-protein snack before you start sucking on a penis Popsicle. OK?

2. Next, PEP (post-exposure prophylaxis) is generally recommended only for very significant HIV exposures. If PEP is warranted, the treatment should be for 28 days. HIV testing during PEP should not include PCR testing, as antiretroviral drugs could decrease the viral load (PCR) to undetectable levels, thereby rendering the test useless for diagnostic purposes. Perhaps your doc is a bit confused on some basic HIV testing and treatment concepts. I'd suggest you consult with an HIV specialist to better evaluate your HIV risk, need for PEP and, if necessary, PEP treatment and follow-up.

3. PEP does not delay the immunologic response to HIV infection, i.e. the production of anti-HIV antibodies. It can, as I mentioned above, decrease HIV viral load. That, however, is not an immunologic response, but rather a direct measure of viral replication.

Hope that helps. I'm here if you need me. Good luck.

Dr. Bob



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