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PEP Combo..is this a potent one???
May 16, 2006

Hi There!

Hope these few words find you doing well!

I'm a 20 year young male from NJ. After a brief unprotected exposure (about 25 secs)of insertive anal sex with a man of unknown status, I decided to go to an ER 4 hours later and inquire about PEP. They prescribed Combivir and Kaletra...1 Combivir tablet twice daily...2 Kaletra's twice daily. Is this a good combination of PEP therapy to take for 28 days? Also, I'm beginning to question whether or not I should even be on PEP Therapy considering that this is the first time I have had unprotected sex (everything was condomized with no failure) I feel that the odds are astronomically in my favor that I did not contract HIV, even if the guy was postive, from this very brief one time exposure. I did not see any blood on my penis, nor did I have any trouble pentrating as I slid right in with ease. Then again, I'm not an HIV/AIDS expert as you sir, and I would greatly value your opinion, because frankly, YOU ARE....DA MAN!!! I was also tested for syphllis and gonnarheea that came back negative, and believe me, the penis swabbing ISNT fun!!!!

I am aware of the stats that the estimated risk for infection of HIV while performing Insertive Anal to a person known to be positive is 6.5 per 10,000 exposures. It's relatively small, but STILL..it's a risk. Keep in mind that I have never once had receptive anal...never been fingered...sucked maybe 2 cocks in a period of 1 year...This man to man anal thing was kind of a first time experience for me, and a frightening one at that.

Let this be a lesson learned to not only me, but to other readers out there who are in the same situation as myself...be it gay, bi, straight, curious, republican, ethiopian etc etc. Wear a raincoat, because someday you may be that unlucky one, it it's going to downpour. Think with the head you have on your shoulders, not with the head on top of your babymaker.

Thanks Dr Bob for reading, and possibly answering my lengthy question. Now I Have to poop (side effect of the PEP) LOLOL!

PS Do you ever take a break? LOL you seem like a busy man!!! Also, I PROMISE TO DONATE...it's just that bills hit me hard this month, and yesterday being mothers day and taking her out to a fancy schmanzy Italian joint, I'm almost broke!

Thanks!!

-J

Response from Dr. Frascino

Hi J,

Being Italian, how could I refuse to answer someone who takes Mom to a "fancy schmancy Italian joint" for Mother's Day???

Regarding your HIV risk, I agree it's very low, but not completely nonexistent. In situations like this, PEP is sometimes "offered," but not really encouraged. When in doubt, we advise the ER doctors to offer PEP and then have the patient see an HIV specialist over the next few days. The specialist can then more completely evaluate the risk and discuss the pros and cons of PEP. In addition, he would manage any PEP-related side effects, like your frequent trips to the pooper, and arrange for follow-up testing. This may be your best option if you are wondering if PEP is warranted or not, and also if you decide to continue with the full 28-day course. You can find a list of certified HIV specialist in your area by checking the American Academy of HIV Medicine's Web site, www.aahivm.org. They have a listing of HIV/AIDS specialists by locale.

From what you've told me so far, would I recommend PEP? I would not encourage it.

Finally, as for being a busy man, yep! Guilty as charged. Sometimes I don't even have time to poop, even though I, too, am on Kaletra at the moment!

J, I agree the odds remain astronomically in your favor, but I'll send my best good-luck/good-health karma nonetheless in hopes that your definitive HIV test is negative (as I strongly suspect it will be).

Stay safe and you'll stay well. Continue to be kind to Mamma, as it generates additional good karma. (See, it already got your question answered promptly! Karma rocks!)

Ciao!

Dr. Bob



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