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Please Help!
Dec 16, 2009

On December 10th, I had unprotected oral giving and vaginal sex with I thought was a clean girl. On Saturday she texted me and told me she found out she is HIV+. I went to the ER and they gave me an HIV test, pills and a prescription. I tried to fill the presciption asap but the pharmacy told me to pick it up Monday at 12pm. I took the meds but then after reading your cite and others they said take the meds within 72 hours. Can you please explain to me if I am doing good in taking the meds, what steps can I help protect my family from getting the virus. I am a 33 year old male that is married to a female and have four kids!

Response from Dr. Frascino

Hello,

You had unprotected sex with someone you thought was a clean girl??? That means you broke Dr. Bob's number one and number two rules!

Dr. Bob's #1 rule: You must always assume the person you are having sex with could be HIV infected and therefore you must take all necessary precautions to prevent the potential transmission of the virus.

Dr. Bob's #2 rule: Always remember rule #1.

I'm shocked the ER didn't impress upon you the necessity of beginning your post-exposure prophylaxis (PEP) immediately. I'm even more shocked that the pharmacy told you to pick up the medications several days later! PEP is most effective when taken immediately after an HIV exposure. The longer the interval from exposure to first dose of PEP, the less likely PEP will be effective in aborting a potential HIV infection. If more than 72 hours has lapsed from the time of exposure, PEP is no longer recommended. You missed your PEP window and hence it is extremely unlikely it will be of any benefit to you. I recommend that anyone who has had an HIV exposure significant enough to warrant a course of PEP be followed by an HIV specialist physician during their 28-day course of treatment. If you are under the care of an HIV specialist, you can also check with him regarding whether to continue PEP.

As for how to protect your family, I would recommend:

Level with your wife. It's the right thing to do. You'll need to use latex (or polyurethane) condoms for penetrative sex with her until your HIV-negative status can be definitively reconfirmed.

You'll need HIV-antibody tests at the three- and six-month marks. (The six-month test is necessary because you had a significant exposure to someone confirmed to be HIV infected.)

Regarding your kids, you can review the information in the archives of this forum in the chapters on non-sexual HIV transmission and prevention. Basically HIV is not transmitted by casual contact.

Good luck.

Dr. Bob



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