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HIV+ Gay Partner
Dec 2, 2008

Hi Doctor:

This is a very resourceful site for HIV info, thank you doc! But, still am worried and hope you dont mind to give better advise.

I sent a couple of questions a a few days ago before thanksgiving. But, didn't see my answer posted here today, thought I send out this again.

I had a relationship with a guy started April this year. We both are HIV neg when we first met. Because of our negative HIV status we didn't engage in protected sex.

While we both are top/bottom vice-versa. But most of the time I am on top.

Months has gone by, he tested negative end of May...negative. Still we didnt even think about to practise safe sex. The last time he top me was in September.

On November the 1st, we both tested again. He came back positive on both rapid and rna test and I am negative. While he also tested positive for Chlamydia (urethra), and myself Chlamydia positive as well (rectal). We get treated right away with Doxycycline 100mg bid.

On November 3rd I started taking PEP meds as well.

His viral load as of last week was 17,000, and CD4 count was 650. That is scary! 17,000 copies/ML per blood. I am extremely worried at this moment.

I still have a few more days before finishing up PEP and required to have test again at least 2 weeks after PEP has discontinued.

My questions:

1.Is the number tells me I am in high risk to get infected?

2. We had protected sex last week while on PEP, then I found out the condom broke when I pull out. Do I still need to continue another 28 days PEP cycle?

3. Chlamydia increase risk of HIV infection?

4. So I go do more test other than HIV and STD?

Please advise. Thank you.

Mr.Worried.

Response from Dr. Frascino

Hello Mr. Worried,

Unfortunately, I agree your worries are legitimate. I'll make several comments that will hopefully help you confront your current conundrum.

First, I should mention that PEP was not advisable in your situation. Post-exposure prophylaxis is most effective when begun immediately after an exposure. If more than 72 hours have elapsed since an exposure, as in your case, PEP is no longer recommended. Are you under the care of an HIV specialist? I recommend an HIV specialist be involved for anyone who has had an exposure significant enough to warrant consideration of a course of PEP. An HIV specialist would also evaluate your recent condom-failure event and advise whether PEP was warranted. It most likely would be warranted for this event if it could be started within the 72 hour cut-off. It is true that having a concurrent STD increases the risk for acquiring HIV. As for additional tests, follow the recommendations of your HIV specialist. He'll know what to order based on a thorough medical history, your physical examination and results of tests you've already had done. Finally, I'd recommend you review proper condom techniques, as they rarely fail (break) when used correctly.

Good luck.

Dr. Bob



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