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On PEP, what's the chances?
Nov 2, 2007

After having unprotected sex with a man where I was the insertive partner, I learned later he was HIV+. I ejaculated inside him and had sores from a previous days encounter on my penis. What are the chances I might have the infection? As this man didn't tell me he was positive until many hours later, it was almost exactly 48 hours after the incident that I took my first course of Kaletra and Combivir.

The side effects don't worry me as these things could be saving my life, and will take them all until the end of the course, but my question is, when can I safely know my HIV status? I'm told tests will occur at 1, 3 & 6 months, is the 6 month test the one to take notice of or is the three month test a good indication? What are the statistics please?

Response from Dr. Frascino

Suddenly you are wondering about statistical risk, chances of acquiring HIV from unprotected anal sex and the predictive value of various post-PEP HIV-screening tests. All of this concern was generated solely because you found out after the fact that one of your partners is HIV positive. What if you hadn't found out? Your risk would still be the same and most likely you would be continuing to put yourself at risk by having unprotected sex. And what about previous partners who may have been HIV positive? I continue to be amazed and frustrated by the number of folks who freely have unsafe sex willy-nilly with every Tom, Dick and Harry (or Tom's hairy dick?), but then freak out the moment they find out one of their partners was "virally enhanced." It just doesn't make much sense to me. We must consider the possibility that all of our sexual partners could be HIV positive and take all necessary precautions to prevent becoming infected. Your story is yet another indication of how ineffective our HIV awareness and prevention programs currently are. I'm not trying to chastise you or be judgmental in any way; it's just that the number of stories like yours seem to be increasing rather than decreasing of late.

To answer your specific questions:

1. What are the chances of infection? I cannot give you an exact statistical risk for your particular situation, as there are far too many variables to consider. For instance, I have no way of evaluating the severity of the "sores on the penis from a previous days encounter." Nor do I know your partner's plasma HIV viral load, etc., etc., etc. What I can advise is that anal sex carries the highest statistical risk for HIV transmission. The receptive partner, as in all types of penetrative sex, is at a higher risk than the insertive partner. PEP and post-PEP testing out to 6 months is warranted.

2. The post-PEP testing guidelines do recommend testing out to six months, as you indicate. Certainly negative tests at the one- and three-month marks would be encouraging. However, the WOO-HOO won't be certified until that six-month negative result.

Good luck. I'm sure you've now learned that unsafe sex is not worth the potential catastrophic risk. I'm hopeful that your experience may resonate with others who are still playing the dangerous sexual Russian roulette game.

Dr. Bob



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