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Possibilty that I transmitted the virus....
Mar 1, 2009

I am pretty worried as last night I messed up and had unprotected sex with a good friend after drinking. I have been positive since April of '07 and on Atripla since July of '07. I have been undetectable for the last year and have not missed a single dose of my meds. My question is, we had sex last night, I was the bottom, we didn't use lube and there was some bleeding. He knew that I have HIV but now he is worried and I am feeling terrible. I heard there is a regimen he could take after 72 hours of exposure that might help stop transmission if he was exsposed, should i tell him to go do it or was it low risk sex?

Response from Dr. Frascino

Hello,

I agree this was a serious lapse in judgment on both your parts. Unprotected anal sex carries the highest risk for HIV sexual transmission/acquisition. Consequently your friend's risk is significant and post-exposure prophylaxis (PEP) would be warranted. PEP should be started as soon as possible and no later than 72 hours after a significant HIV exposure. Your buddy should begin treatment ASAP. The earlier it's started the better the chance PEP will abort HIV transmission. He should be able to access PEP at any emergency room, urgent care clinic or HIV specialist's office. Perhaps your HIV specialist would be willing to get him started and follow him through his 28-day course of treatment.

As far as assessing his risk, he has some factors that are encouraging and others that are not. On the encouraging side is that you are on effective combination antiretroviral therapy and have an undetectable plasma viral load. Also, an insertive (top) partner is at less risk than a receptive (bottom) partner. On the not-so-encouraging side is that there was some trauma and bleeding during the episode. Plus there is new information suggesting that HIV transmission can occur even when the plasma viral load is driven down to undetectable levels. (See below.) Also, time is ticking by and the longer your buddy waits the less likely PEP will be effective.

I'm sure this has been a major wakeup call for both you and your buddy. Let's hope no harm was done.

Good luck to you both.

Dr. Bob



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