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While on PEP, can i still transmit a virus to another negative homosexual
Nov 13, 2009

Hi Doctor, I always practice safe gay sex However I had an unprotected gay sex encounter with a guy who bragged about getting laid by more than 200 different people and celebrities. Since he was insisting for the night and I was excited we drank and made out the whole night. We had indulged in themes like "rape the kiddo " Violent anal sex with rapid and deep thrusts intended to cause agony n trauma to the anus. This was without Condoms. We fisted deep throated , I was the TOP (active penetrator "in slang FUCKER" ) and my partner was the Bottom (receiver). I ejaculated in him and after i withdrew he was leaking with a semi-viscous mixture of semen blood and some slimy anal wall mucous that looked like jelly. Since I was drunk, i didnt realised what a horrible risk , i placed myself in.

The following day, after coming to my senses, I started thinking n thinking about this encounter and getting freaked out. I called this same guy one-time sex partner (who claimed to be a gay slut) and sweet talked him to lunch, an HIV Elisa test followed by a movie. He was reluctant and initially resisted and made excuses saying " oh Im safe, Im strong,dont worry nothing will happen to me, its all fate "

But an inner -voice told me to be assertive and test. I offered to pay for his test as well as mine. We went to the Diagnostic lab, Asked for HIV (Elisa method) for both of us. The result was ready by six in the evening after about 5 hours, At 3pm, he receives a call asking him to come back and give another sample of blood. I did not get a call.

We Go there at 6pm, i ask for my result, they give it to me Result : SEROEGATIVE for HIV1/ HIV2 antibdies .

However,his result was WITHHELD -Further investigation required. They ask him to go speak to the lab technician who tested his Blood sample. The LAB Technician said its turned out Positive and they wanted to do another test by ELISA itself to reconfirm it for him. (Here in Bangalore, INDIA they dont perform Western BLOT , its ELISA followed by another ELISA if the first Elisa test was positive and finally a HIV RNA PCR /viral load test for confirmed or still confusing Elisa results).

I was shattered, My baseline HIV test wAs negative (done at 36 hours POST exposure to an HIV positive patient. BUT he was SEROPOSITIVE....HOLY GOD

I immediately Rushed to a Big hospital and got an appointment with a GP. I narrated to him the story but made it sound as if it was a hetero-sexual exposure to an HIV positive woman ( if you admit to Gay sex in india, its still illegal to have MSM , they can call the cops and put you behind bars for a maximum of 10 years).So i wanted to be on the safer side or atleast not get frowned upon by the consulting GP (gay sex is still Taboo and the doctor was an old retired army colonel who served in the INDIAN ARMY MEDICAL CORPS)

He said ."No need of PEP" , but i cried and literally begged him to put me on PEP regimen. Here in India, Truvada and Kaletra cannot be bought over the counter, You HAVE to have a docs perscription and time was running out for me the 72 hour deadline . I put up a drama there begging him "please let me live, even if i dont die of HIV , i will die of the stress and tension plz plz. He finally obliged just to get rid of me, He Prescribed TRUVADA once daily and Kaletra twice daily for 30 days time + ordered a HIV Viral Load test for me (although the same day HIV report was negative. I asked him how much were the drugs and the HIV RNA test, I almsot fainted after knowing the total cost, the PCr test was damn unaffordable. I never knew the drugs were so costly and didnt have money at that moment. called my friends immedaitely and they borrowed a couple thousand rupees from them and ensured , i bought both the drugs and started them...I postponed the test for later as i dint have cash nor thot it more important at that time.

My first Truvada tablet was taken 49 hours post exposure and first kaletra tablet 53 hours Post exposure. Im taking the medicines religiously and stopped having sex in the mean while. there arent any horrible side effects , except feeling like throwing up, loose motions and general malaise and not in mood for anything :-( with this combination of Kaletra and truvada. Also i dont get any erections or mood for sex at all.

However, i have a new boyfriend who is HIV negative (Presumed) as he rarely has sex and stays in a conservative family. here in india its slightly different.

He generally loves unprotected sex. He always loves to drink my sperms "spunk". Im planning to meet him 12 days post exposure and on PEP regimen. Was wondering whether Can i have sex with him unprotected and let him drink my sperm ? Even though im seronegative and taking powerful Truvada + kaletra, can he get infected by the possible few HIV virions the may be in my blood or spunk ? or will it be fine ?

Also, Is it okay to take VIAGRA (sidenafil citrate 50 mg) before i have sex with my guy ? Im 24 yrs old, no history of cardiac, no hypertension, no renal complications and in general good health. I've tried viagra before and it didnt affect me much.. heard kaletra interacts with Viagra..but to what extent, im going to travel more than 15 hours to meet my guy . So i need to give hima good sexual experience and with these drugs now, i dont have any mood or energy to even think of having sex with him. Plz advise me if Viagra 50 mg along with my regimen is safe, or should i reduce the dose to 25mg ?

Also, should i take do the HIV RNA PCR / viral load test after 10 days post exposure, Or since im taking PEP, the result will not be accurate ?

The hospital is also offering HIV DNA PCR. Is it advisable to go for it as its thousands of Rupees cheaper than the RNA viral load test. Would it benefit me ? any of the two test 10-14 days post exposure and while on truvada+ kaletra ?

I know that i wrote alot, but my intention si to narrate everything to you without any hidden facts. Also this long question/article might be informative to many readers. Thans to all you doctors who do a wonderful job of helping people Virtually. May the almighty God Bless all of you guys for this noble service :-)

Response from Dr. Frascino

Hello,

You "always practice safe gay sex," except apparently for unprotected "rape the kiddo . . . violent anal sex with rapid and deep thrusts intended to cause agony and trauma to the anus . . . fisting . . . deep throating . . ." etc. Sorry, but I really don't think you can claim to "always" practice safe sex anymore. Your sexcapades with the self-proclaimed "gay slut" were very high risk. It is not at all surprising that your partner tested HIV positive. Worrisome is that he didn't know he was positive and consequently was not on antiretroviral therapy. Consequently, it's likely his HIV plasma viral load was extremely high, thereby further increasing your HIV-acquisition risk.

I disagree with your GP: PEP was absolutely indicated! Perhaps because you could not be honest about the details of your sexual experience, your GP's judgment was clouded.

You should take the Truvada and Kaletra as prescribed for a full 28 days. HIV PCR RNA testing would not be helpful or warranted while on PEP. Save your money!

Regarding your new boyfriend from the conservative family who is "presumed" HIV negative, do not have unprotected sex with him! I would suggest you encourage him to get HIV tested to determine his HIV status definitively and then to counsel him never to have unprotected sex, no matter how much he "loves unprotected sex." Perhaps you could even be upfront about your recent experience and that you are now taking PEP.

When Viagra (sildenafil) is co-administered with Kaletra (lopinavir/ritonavir), the dose of Viagra should be limited to 25 milligrams within a 48-hour period, due to drug-drug interactions. So to answer your question, yes, you should reduce your Viagra dose to 25 mg and not take it any more frequently than every 48 hours.

Regarding qualitative HIV PCR DNA and/or quantitative HIV PCR RNA tests, I would advise against these, as the results would not be accurate while you are on PEP. Also,a they generally are not recommended for routine HIV diagnostic screening. The post-PEP HIV testing guidelines recommend an HIV-antibody test (ELISA) at six weeks, three months and six months from the date of exposure.

Finally, I should point out that criminalizing homosexuality is immoral and unconscionable. As in your case, it can lead to less than optimal healthcare treatment, because people are unable to be honest with their physicians regarding their sexual orientation and actions. Taboo or not, this must change. I urge you, others living in India and the world community to put pressure on the Indian government to abolish this discriminatory law. Unjust laws, such as these, fan the flames of the AIDS pandemic.

Good luck with your upcoming tests.

Dr. Bob



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