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Culliningus and unwarranted PEP
Jun 18, 2009

Dr. Bob,

You are no wonder the shining star in our nightly sky!

My story: Protected vaginal sex with a street-based SW in Thailand. I also lunched very briefly at the Y (clitorus-licking) and there were no "extenuating" circumstances. When I noticed the C-section scars on her tummy I somehow got scared and took Combivir within 30 hours of exposure and for 28 days. My three-month post-exposure HIV 1/2 antibody testing (both rapid and conventional) came back negative.

My questions:

1. Is my recent test result Dr. Bob-certified-Woohooable? 2. I am not sure about the HIV infection kenetics. Why can't a "lighter" exposure/challenge take a longer time to seroconvert?

Your worried fan in Canada

Response from Dr. Frascino

Hello Worried Canuck,

Protected vaginal sex plus a brief lunch at the Y without extenuating circumstances with a pro of unknown HIV serostatus would not warrant a course of PEP. To address your specific questions:

1. Your negative 3 month HIV test would be WOO-HOO-able based on your degree of HIV risk. However, if the exposure warranted PEP, the guidelines recommend follow-up HIV-antibody testing at six weeks, three months and six months.

2. HIV doesn't work that way! Once HIV gains access and establishes infection it divides very rapidly (i.e. billions of times per day). HIV seroconversion is based on the body's immune system producing anti-HIV antibodies in response to the infection. Billions of replications are plenty of stimulus for the immune system to manufacture anti-HIV antibodies. The vast majority of HIV-infected folks (no matter how large or small the inoculum or route of infection) will have detectable levels of anti-HIV antibodies in their blood within four to six weeks.

Be well.

Dr. Bob



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