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wish i had ur arm around my neck as i tell u this
Mar 19, 2007

hello sir,i am writing this mail again in anticipation that it will be answered.i am a 26 yrs old medical professional and am really cautious about getting infected.i never indulged in penetrative sex before this time when i really felt i was living a half fulfilled life.i allowed someone to have penetrative anal sex with me with a condom and it broke.though he widrew..there was some seminal fluid exchange for sure.i panicked and asked the person to go for a rapid elisa tridot.to my horror it came indeterminate.i immediately started zidovudine and lamivudine combination from the third hour of exposure.i started nelfinavir after 20 hour post exposure when the source tested posative for hiv antibodies.i have lost my sleep over it.got dna pcr done at twelth day and it was negative.how reliable is this report in settin of pep.my 28th day of regime got over today.should i go for repeat dna pcr...?

one thing more.....if i do test posative....i wish to do something akin to what you are doing till my last breath.if i test negative i will go on with my life as usual but will promoteawareness amongst youngsters about hiv.

and i really wish i was sittin with you with your arms around my shoulde when i say this to you and i almost felt your pat of reassurance as you read this on.....

obliged...with a tear a resident doctor

Response from Dr. Frascino

Hello,

I don't recommend PCR testing for routine HIV screening, due to the rate of false-positives, other technical considerations and cost. For a significant HIV exposure requiring PEP, the screening test to use is an HIV-antibody assay. Testing is recommended at baseline, four-six weeks, three months and six months. At this point, you are taking three-drug PEP and therefore doing everything you can to prevent infection. Remember, the statistical odds are still very much in your favor. The estimated per-act risk for acquiring HIV from unprotected receptive anal sex is 50 per 10,000 exposures to an infected source.

Since you are a medical resident, I suggest you download the complete published (updated) recommendations from the U.S. Dept. of Health and Human Services: "Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States." You can find this on the CDC's Web site.

Finally, as for me putting my arm around your neck, just close your eyes. I'm there, OK?

Good luck. We'll get through this together.

Dr. Bob



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