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Post Exposure Prophylaxis (PEP) for 19 y/o male
Jun 30, 2008

Hi,

I'm a 19 y/o gay male. I had unprotected receptive anal intercourse with a man that I had known for almost two weeks. The person states as of January of 2008 he was negative. I don't know what to believe.

The encounter was in the shower and I do not know if his bodily exchange fluid (semen) and passed.

This was on a friday evening around 6pm. Sunday afternoon around 5pm I called my doctor was told to start PEP for possible HIV infection.

The doctor has me on (2) Lexiva @ 7oo mg coupled with one capsule of Norvir and a daily dose of Truveda. Since then my mind has been rather in the fog somewhat and tired. I'm trying to keep to normal daily activities as much as possible. My doctor says none of the med's would warrant any possible mental side effects.

My other concern revolves around the timing of starting this treatment. It began about 40 after possible exposure. The CDC recommends medication within no more of 72 hours. However I have read other public health agencies and it says 48 hours. I'm under the belief that the conversion occurs with this timeframe. I am worried it might not work. I wanted to know if I should be worried. My doctor said knock on wood you should hopefully be fine. I've been very anxious somewhat and tried not thinking about it. Is my medication regimen suitable for voiding conversion from HIV? I'm on it for 30 days. Additionally the doctor put on other preventive measures such as Doxycycline for possible STD's as a preventive measure and I was given two injections of Syphillis intra-muscularly (It hurt)

Response from Dr. Frascino

Hello,

You had an unprotected anal receptive encounter with a guy of unknown HIV status (who told you he was negative as of January 2008) and you have no idea "if his bodily exchange fluid and passed." And for this your doctor gave you doxycycline to prevent STDs and two intramuscular injections to prevent syphilis plus started you on PEP (Lexiva plus Norvir boost plus Truvada). Wow! You did tell your doctor you only had this one single shower-adventure involving only one guy with unknown HIV serostatus and questionable exposure to semen as opposed to telling him that you did the unsafe mattress mambo with every dude who came to a gay bathhouse during the entire Gay Pride week in NYC, didn't you? It seems to me your doctor is being somewhat over-aggressive, unless he has some personal knowledge about the shower-guy that we don't know. At any rate, my advice is that anyone who feels they have had an HIV exposure significant enough to warrant a course of PEP should be followed by an HIV specialist. The specialist will review and document your degree of risk; optimize, adjust or perhaps even stop your PEP as indicated; evaluate and manage any PEP-related side effects or toxicities; evaluate any other symptoms that might develop during the course of PEP; and arrange for and interpret all post-PEP HIV tests.

Is your medication regimen suitable? The dosages are correct, but whether or not it was warranted may be another story. Additional history would be helpful in making that determination. The HIV specialist will help you in this regard. PEP is generally only recommended for significant HIV exposures. I trust you've also now realized unsafe sex is not worth the painful shots in the butt let alone the other potential catastrophic consequences!

Good luck.

Dr. Bob



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