Magnetic couple and PEP
Jun 7, 2009
Dear Dr. Frascino,
First of all I would like to thank you for all the wonderfull work you are doing here at "The body", and for all your patience and understanding. But above all I like your sense of humor. I'm 39 years old HIV- single mother of a wonderfull 5 years old girl and I've been involved in a relationship with HIV+ man for 8 months. I love him deeply, but I live in fear of being infected and dwell between my dughter's future and keeping the love of my life. We have always had protected sex, but at the begining of our relationship we had a condom breakage so I had my test done at 2,3,6 and 7 months mark and all came back negative, so I assume I've doged the HIV bullet this time. His Cd count is 400 and his viral load undetectible.He takes epivir, ritonavir, darunavir and MK-0518 (insentress)and he's doin' fine with no side effects whatsoever. BTW, I forgeot to mention that we live in Serbia and in my country this medications are free. But you may well understand that we are lacking a lot of information, and also there is no real support for magnetic couples, so we are kind of on our own. Most of the HIV related issues I learned form your site and I'm so gratefull to you. I've gone through the archieves and I read all relevant and important chapters of the forum, so I won't bother you with my pain, fears, anxiety and concerns, cause you have heard all that like zillions of times, but I only have few questions: My first question is do I have to take test on 6 months mark even if there is no condom failure? (I have to mention that we have only vaginal sex, he never comes inside of me, we avoid doing anything during my period, I don't perform oral to him but he does to me with no protection and he takes well care of his oral hygene and has no cuts, sores etc.) My second question is PEP related. I read that the virus "invades" the body within 8 hours after exposure. PEP should be taken within 72 hours and if I understood well PEP is the combination of the same drugs as for HIV. So if this is the case, how come that the medications can't cure the infected person yet they can prevent the infection after exposure? It also goes for PrEP. I don't have a chance to talk to my boyfriend's HIV specialist because he is always busy with infected persons and there are only 3 HIV experts working at infectious deseases clinic, so there is really no one to answer my qustions other than you. Consequently, you might hear from me few more times :-).
I have to apologize for my English but I'm not a native speaker, and I hope you'll figure out what I'm asking about. God bless you and I wish all the best for you and your Mr. Right. BTW, how did both of you manged to survive in a magnectic realtionship for 15 years? Could you please share your secret with me? Thanks a bunch Doc! Nicky
Response from Dr. Frascino
Regarding your broken-condom incident, yes indeed you dodged the HIV bullet because your negative HIV tests out to seven months are definitive and conclusive. (By the way, your six-month result was also definitive and conclusive!)
As for routine HIV testing, that's a personal decision. Guidelines do exist that recommend routine STD testing, including HIV every six months for people who are sexually active with multiple partners. If your relationship is monogamous, I do not feel routine HIV testing every six months is necessary. An HIV test at the time of your routine annual physical examination would be more than sufficient assuming there have been no accidental exposures in the interim.
Your PEP/PrEP question is a bit more complicated to answer. Basically there is a big difference between preventing or aborting a potential HIV infection immediately after exposure (before the virus has had the opportunity to seed critical immune structures and establish chronic reservoirs that HIV medications cannot reach) and curing a chronically infected HIVer. HIV medications work on different parts of the viral life cycle. If we can get HIV medications onboard before (or shortly after) an HIV exposure, the medications plus our innate immune system can in most (although not all) cases prevent HIV from establishing itself. HIV medications, however, have not been able to totally eradiate an HIV infection that has become chronic (established), primarily due to HIV reservoirs where HIV can "hide" within the body.
As for my magnetic relationship with Steve (Dr. Steve, the expert in The Body's Tratamientos forum), there really is no secret. HIV is essentially 100% preventable if proper precautions are taken. We adhere to those precautions. I'll reprint below some information from the archives that discusses some harm-reduction strategies for magnetic couples. I don't believe you have to "dwell between your daughter's future and keeping the love of (your) life." Rather, just become informed, follow the harm-reduction strategies and know what to do in case there is an accidental exposure, such as condom breakage (take PEP immediately). Also, please note condoms very rarely fail if they are used properly! I see absolutely no reason why you and your positively charged Prince Charming shouldn't live happily ever after. I certainly plan to!
condom failed (HARM REDUCTION STRATEGIES FOR MAGNETIC COUPLES, 2009) May 27, 2009
I am an hiv neg. female, my boyfriend has been hiv pos. for 20 years.and his viral load has always been undetectable.3 nights ago,after sex, we realized the condom had come off and was still inside me,it took some digging, but he got it out.and it was evident that he had come inside me.. afterwards, i started spotting, and started my period the next day. wich has me concerned.i get tested every 4 to 6 months, and had just been tested a week before..i am not going to get all stressed out about it,i know nothing is ever 100% safe,and it can only make things harder. but, the fact that i was bleeding a little has me worried.. how likely is it i've been infected ?, and how long should i wait to get tested again?.this is the first, and hopefuly the last accident we have had.!!
Response from Dr. Frascino
Condom failure does place you at some degree of risk for HIV. That your positive boyfriend has an undetectable HIV plasma viral load would significantly decrease the risk of HIV transmission. However, your spotting may increase the HIV-transmission risk. In situations where there has been a significant HIV exposure, post-exposure prophylaxis (PEP) would be warranted if it can be started soon and no later than 72 hours after the exposure. Your exposure was three nights ago; consequently, this is no longer an option for you. But I would encourage you and your boyfriend to review the information about harm-reduction strategies for magnetic couples in the archives of this forum. We have an entire chapter devoted to magnetic couples. I'll reprint below a sample of what can be found there. At this point we would recommend you have an HIV-antibody test at the three- and six-month marks. The six-month test is recommended by the CDC because you had a significant HIV exposure from a partner confirmed to be HIV positive.
Good luck. I agree getting all stressed out won't help!
Undetectable Viral Load in Semen MAGNETIC COUPLE SEXUAL RISK 2009) May 26, 2009
A "big G'day" from Australia to you, Doctor Bob!
I am an HIV positive male involved in a relationship with an HIV negative female.
I have been on Atripla (or the Aussie equivalent) for a year now, and for 10 of those months been undetectable.
My girlfriend and I always practice safe sex - I wouldn't put her at risk for anything!
However, during sex last night, the condom broke. We were unaware that it broke and probably had vaginal intercourse for about 15 minutes before realising it had snapped.
I did not ejaculate inside her, but (obviously), can't tell you how much pre-cum would have "leaked" during this 10 minute period.
What are the chances she would have contracted HIV from me?
We are both frantically worried about it and it is putting a strain on our (otherwise wonderful) relationship.
I have read that a recent Swiss study found that a consistent undetectable viral load in the blood correlated with the semen, but I have read other reports that say this might now be the case.
I am hoping that being undetectable and not cumming inside her stacks the odds well and truly in her favour. What would be the chances of her contracting something from this one-off incident?
Thanks if you can shed any light on the matter, and good luck to you and your partner in your own magnetic relationship - opposites attract!!
All the best, Oz Boy. xx
Response from Dr. Frascino
Hello Boy from Oz,
Here's what we know:
1. The HIV plasma viral load usually, but not always, correlates with the HIV viral load in semen (or cervical secretions).
2. Having an undetectable HIV plasma viral load significantly decreases the chances of HIV transmission.
3. Not ejaculating in the love canal significantly decreases the chance of HIV transmission.
4. PEP (post-exposure prophylaxis) taken as soon as possible and no later than 72 hours after an exposure can decrease the chance of HIV transmission. (You can read much more about PEP in the archives.)
To specifically answer your question, the odds are very much in your girlfriend's favor. However, HIV testing is still warranted. I would also recommend you and your gal-pal review the harm-reduction strategies available for magnetic couples (PEP, PrEP, proper condom use, etc.). I'll reprint below some information from the archives. Please note we have an entire chapter devoted to magnetic couples.
Good luck from one magnetic couple to another! Magnetic couples rock!
Hiv infection? Magnet couple stress and fear (MAGNETIC COUPLE SEXUAL RISK 2008) Oct 8, 2008
I am negative at the moment and my boyfreind is HIV positive. he is an HIV educator actually.
After I accepted his status, we finally became intimate with each other. I did oral sex on him 3 times that night. Twice on his penis and once with his ass. He precums almost instantly (I don't know if its just with me lol), but I feel like despite the wealth of knowledge about the risk of unprotected oral sex I feel like I may have exposed myself. I didnt not swallow much if any precum. I had a little after taste and I mouthwashed mid session. I only have minor gum bleed after toothbrushing. I am a little concerned about anal oral intercourse too even thought I saw no possible way i could get infected. He penetrated me with a condom and i am not concerned about infection there.
I just want to feel a little assured about my chances for infection here. I love him so much and I find it hard to be intimate with him without thinking about his status. It's a reason why I can't put myself in a condition to penetrate him. And I feel horrible even thinking about talking to him about it because he is an HIV educator and probably know more than most about safe sex practices. Gawd, Just thinking about it and letting my mind run amok about possible infection makes me want to cry becasue I dont want to hurt nor loose him, but I want to trust him with us and our intimacy. And I want to be able to give him my all when we make love without holding myself back.
Given what I said, what were my exposure risks. And what advise do you have for me and the relationship with the one i can see myself with forever?
Response from Dr. Frascino
Your HIV-acquisition risk is extremely low. There have been no documented cases of HIV transmission due to rimming or getting rimmed. Oral sex carries only a very slight risk for HIV acquisition/transmission. You can read much more about this in the archives of this forum. We have entire chapters devoted to oral sex and sexual-HIV transmission risk.
Regarding your concerns about sexual activity within a magnetic relationship, as you might imagine, you are not alone. It's something all magnetic couples must come to terms with. Communication is key and that is what is lacking in your current relationship! That your Mr. Right is an HIV educator should make communication easier, not more difficult! Chances are he's as worried about infecting you as you are about acquiring the virus. The two of you are overdue for a heart-to-heart (note that's heart-to-heart, not hard-to-hard) talk! You need to openly discuss your concerns and together the two of you need to develop sexual rituals based on what is known scientifically about the HIV-transmission risk and on your individual levels of comfort. I suggest both you and your Mr. Wonderful read through the chapter in the archives devoted to magnetic couples. You'll soon see your concerns are shared by many of us in serodiscordant relationships. In addition to taking equal responsibility to make sure HIV is not transmitted, there are a number of other measures the two of you might want to consider to further reduce transmission risk:
1. Have your poz-partner take antiretrovirals to drive his HIV plasma viral load down to undetectable levels. This will significantly decrease transmission risk.
2. Get a starter dose of PEP (post-exposure prophylaxis) to have on hand just in case there is an accidental exposure (condom break).
3. Consider PrEP (pre-exposure prophylaxis). This involves the negative partner taking antiretroviral medication prophylactically on a routine basis. We still don't know if this approach is effective. Clinical trials are underway. Some magnetic couples aren't waiting for the results of the trials, but rather are instituting PrEP as a harm-reduction strategy now.
You can read much more about PEP, PrEP and other risk-reduction strategies in the archives.
Finally, I want to assure you from personal experience that opposites attract and that happily-ever-after can indeed become a reality for magnetic couples. Steve (Dr. Steve, the expert in The Body's Tratamientos forum) is HIV negative. I'm "virally enhanced." We've been happily-ever-aftering for 15 years and yes, that includes toe-curling, wake-the-neighbor, own-name-forgetting fusion sex. My advice to you is to make sure Mr. Right doesn't get away for all the wrong reasons.
Good luck to you both!
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