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Should I continue PEP??
Aug 7, 2009

Dear Dr. Bob,

First, I would like to thank you for being so supportive and also for providing people with such a huge wealth of knowledge about HIV.

Now my question, I was having both receptive and insertive oral intercourse with my friend and during that, he also started to rub his penis around my anal region. In the course of this 30-40seconds genital/anal contact I did not feel any pain or discomfort so I wasn't worried about it. After this incident, I started to think more and I started to question whether he might have penetrated me or not during that 30-40 sec. I had never have anal sex before so I don't really know how anal penetration feels like. Since I was worried, I called the HIV hotline and they told me that I should call the infectious disease clinic in my city since I might qualify for PEP. The doctor at ID clinic told me that, I should go to the ER ASAP to get PEP and schedule an appointment with him for 2 days later. So after 5 hours of wait in ER, I finally talked with another Doctor and he started me on Combivir and Kaletra. This was about 65 hours post incident.

Also some info about my partner: we are good friends and I know that he got tested negative 2 months ago. However, I know that he had relationship with few other people in the last 2 months. He told me that I shouldn't be concerned since he's okay. Finally regarding the penetration, he said that he did not recall any. He also mentioned that since there was no lubrication, not only I would've felt it but it would've been very painful and I would've been sore after.

Now I really need you opinion. How do you assess the risk of my incident? Do you warrant PEP? If yes, does 65 hours post incident make the treatment significantly less successful?

Thanks

Response from Dr. Frascino

Hi,

Based on the information provided, I would not have recommended PEP and I would suggest you discontinue it now.

As for PEP efficacy, its chance of aborting an HIV infection decreases proportionately to the time elapsed between HIV exposure and the first dose of PEP. If greater than 72 hours have passed, PEP is no longer considered to be effective.

Regarding your current situation, why not ask your buddy to get a rapid HIV test? If that is negative (as anticipated), this would give you additional reassurance for discontinuing your PEP. (The chances your buddy would still be in his window period are remote at best!)

If you remain concerned about HIV, I would recommend a single HIV-antibody test at the three-month mark only.

Good luck.

Dr. Bob



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