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Unprotected sex with HIV+ person
Sep 10, 2007

Hi Dr Frascino, I am female in my 20s and 19 days ago I had unprotected (vaginal) sex with a guy who is HIV +. At the time I asked him to wear a condom, but he didn't. Afterwards, I asked him why and he said that his 'viral load' was low but I admit that I don't really understand that fully and am so annoyed at myself for not insisting more or stopping things. I guess I trusted him when I shouldn't have and am now very worried.

Whilst he was inside me for some time he didn't ejaculate, either inside or out. He also said that he can tell when he 'pre-cums' and that he didn't.

I have been going through a very difficult stage with my long-term boyfriend (not this guy) and moved out to get some space just before this happened. I am not feeling myself and I think what had happened took a while to sink in, and I have only went to a doctor 6 days after this.

There I was tested for HIV, other STDs/STIs and preganancy. the HIV test was negative, but I know that it is too early to tell from this exposure. To prevent pregnancy I had a IUD fitted, was told that the other STIs were negative but that I have a bacterial infection (vaginal).

Following the doctors advice I am now taking post-exposure prophylaxis (PEP - one neuvimine once and combivir for 30 days) as well as antibiotics for the other infection/prevention of other infections.

Two days after this (so 8 days after the incident) I went back to the doctors as I had tonsillitis. I took antibiotics for this but almost 2 weeks later it hasn't cleared up so they are doing tests for glandular fever/mono and also a PCR test. I will get the results next week. I have generally been feeling unwell, no fever, some days I have had diarrhoea.

My concerns are 1) PEP seems to be 'most effective' or 'usually prescribed' within 72 hours, so I am wondering why I am taking it and what could its effectiveness be? I know there is no guarantee that this will prevent the virus taking hold.

2) What is the risk that I have been infected? Am I experiencing ARS?

3) My doctor advised me to take the PCR test as they were worried about my tonsillitis not clearing up. I have read some things though about PCR tests not being accurate if the person is taking PEP?

I am on the verge of breaking up with my boyfriend because of this mistake, although that is not what i want, and I regret things so much now. I have not told him that the other guy was HIV+ as he knows him and I have been asked to keep his (other guy's) status to myself. WE have not had sex since and if we did we will use condoms. Is it unsafe for him to get any of my vaginal fluids near his penis? Can he rub himself against me but not go inside me?

I am feeling very alone going through this as there is no one i feel I can talk to about this. I am seeing a general counsellor, but they have said that i just need to try not to worry about this until i get conclusive test results. That seems like such a long way off though....

Thanks for listening.

My mind is all over the place and I am seeking couselling as well.

Response from Dr. Frascino

Hello,

You, like many other unfortunate souls, seem to be under the care of a physician who is not adequately versed in basic HIV medicine skills and knowledge! I'll return to that subject in a moment when I respond to your specific questions. First, I should comment about your risk. Having unprotected sex with an HIV-positive guy is obviously an incredible lapse of judgment (and common sense)! What were you thinking? This was certainly not an accident, nor was it due to lack of knowledge! You should very seriously evaluate what led to such a self-destructive behavior so that you will never ever again take such a risk.

Moving on to your questions:

1. PEP should be started as soon as possible, and no later than 72 hours, after an HIV exposure. Beginning it six days after sex makes no sense. It should not have been prescribed.

2. The estimated per-act risk for acquiring HIV from unprotected receptive penile-vaginal sex with an HIV-positive partner is 10 per 10,000 exposures. Are you experiencing ARS? I have absolutely no way of determining whether you are or not based on the information provided but you have placed yourself at significant risk.

3. PCR testing for diagnostic purposes while on PEP may not be accurate, because PEP, which is comprised of potent antiretroviral medications, could drive HIV plasma viral load (PCR) down to undetectable levels, thereby giving a "false-negative" reading.

My advice is that you consult an HIV specialist, as your current physician isn't doing you any favors at the moment. I also agree with your decision to seek counseling. In addition, I would advise you level with your boyfriend. Not only is the best way for you to confront your guilt; it's also the correct thing to do. You and he should definitely use latex condoms for all penetrative sex until your HIV status is confirmed.

Good luck.

Dr. Bob



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