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Please, help me Dr. Bob!
Oct 12, 2007

Dr. Bob, please, I need your expert answer! I wrote you before but had no answer yet. Please, I need your help! I had an insertive anal intercourse with another man an the condom broke (I was the top), and I made a little wound/ulcer on my pennies skin, close to the gland, with apparently no bleeding on my wound or in the rest of the skin (when I took it out, there was no dirt or blood on my pennies). Besides, he gave me oral sex (no skin-ulcer yet on my pennies) , and I gave him oral sex (for a little time, 10-15 seconds, but I think I felt some pre-seminal fluid. My mouth apparently has no bleeding or wound on it). After a rapid hiv test, my partner was hiv+. They made a confirmation test, and they told my partner that he was infected about 2 moths ago, so he possibly can be more infectious, despite of already having antibodies. I started PEP 36 hours after contact, with Kaletra & Truvada, and my doctor says its a low/moderate risk exposure and he is optimistic about the chances of not getting infected if I do my treatment for 30 days. Please, Dr. Bob, according to your experience and knowledge, should I be optimistic? Ive read your info saying that PEP is better when started as soon as possible, but because of the tests I couldnt start it before. Is 36 hours a good time? Is it a low, medium or high risk exposure? Please, I need your info: sometimes this is driving me crazy!!! My doctor told me to make an ELISA test after one month, three months and six months. It means one month after the PEP is finished, or one month since the risk exposure? He told me that a last generation ELISA test after one month will probably show if Im infected or not, but I have to make all of them. Thank you very much for your work, doctor. Please, let me know how can I make a donation to your Fundation.

Response from Dr. Frascino

Hello,

Insertive anal sex with a broken condom carries the same statistical risk for STDs, including HIV, as unprotected insertive anal sex. I have no way of evaluating the "little wound/ulcer on (your) pennies." However, non-intact skin can increase HIV-transmission risk. If your partner was infected recently ("2 'moths' ago") and is not on HIV medications, he could have had a significantly elevated HIV plasma viral load. The risk of HIV transmission increases with high viral loads.

PEP can indeed decrease HIV-transmission risk. You are correct: it is most effective when begun as soon as possible after exposure. So 36 hours is better than 37 hours, but not as good as 35 hours. ELISA tests following exposure or PEP are measured from the time of the HIV exposure.

Should you be optimistic? Well, you've done everything you can for the moment and the statistical odds remain very much in your favor. So yes, I'd recommend following up with your post-PEP HIV testing and remaining optimistic!

Thanks for your donation to The Robert James Frascino AIDS Foundation (www.concertedeffort.org). In return I'll send you my best good-luck/good-health karma that your post-PEP follow-up tests remain negative.

Good luck! Be well!

Dr. Bob



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