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azathioprine and HIV risk.
Oct 13, 2008

Hi Doc, my 'virally inhanced' boyfriend gave me an unprotected blowjob in the heat of passion. I take azathioprine as chronic medication for a stomach ailment and would like to know if this could have increased my risk. I am currently on cortisone as I am having a flair up with my tummy. After the bj I went on Combivir for a month. It has been two weeks since stopping the Combivir, six weeks post exposure. Please advise what diagnostic tests I should have and when? Thanks for all the great work on this great site - to bad there is a need for such a site!

Response from Dr. Frascino

Hello,

Azathioprine would not affect your HIV-antibody test results; however, cortisone might, depending on the dose and duration of the course.

Post-exposure prophylaxis (PEP) is generally not recommended for a single bout of unprotected insertive oral sex. As I have said many times before in the forum, anyone who has had an HIV exposure significant enough to warrant a course of PEP should be followed by an HIV physician specialist. Chances are if an HIV specialist had evaluated you shortly after your heat-of-passion blowjob and being started on Combivir, he would have stopped your PEP. An HIV specialist would also evaluate any intercurrent symptoms that might arise and arrange for follow-up HIV testing as needed. In your case, if your course of cortisone is brief, you should follow PEP testing guidelines, getting an HIV-antibody test at baseline, six weeks, three months and six months. If your dose of cortisone is high and the course is prolonged, you may need PCR DNA qualitative testing, rather than the usual antibody-dependent HIV screening test.

Dr. Bob



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