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Dec 27, 2009

Hi Dr.Frascino,

I would start out by thanking you for your work on this forum as reading other people's questions and answers has helped me to cope with the most difficult time in my life. Plesae forgive me if you have already answered this question, but I have not seen the answer to this is any former forums. In May of this year I performed unprotected oral sex on a man of unknown HIV status, this was a stupid hasty drunken decision that I will never do again. Roughly 48 hours after the exposure my doctor put me on PEP, which consisted of a 28 day course of Atripla. On day 20 I saw an infectious disease specialist who did not think my risk was sufficient enough to be on PEP, and he advised me to stop taking the medications which I did.

Subsequently I tested negative for HIV antibodies 3 and 6 months post expsoure. I recently started grad school at another city so my 6 month test took place at my school's health center, where that doctor advised that I come back to test again at the one year mark post exposure due to the fact that few people have delayed seroconversion. This is the first time I was told that I have to test again at one year, as I believed my 6 month test would be my last. What are your thoughts on the validity of my negative tests so far? This last test has been causing me a lot of anxiety and input from you would be very appreciated because I look up to you a lot.

Thank You,

Anxious/Scared Girl

Response from Dr. Frascino

Hello Anxious/Scared Girl,

It seems you are continuing to get not only anxiety-provoking but also incorrect medical advice from various physicians! Hopefully the following sound medical advice will allow your fears to melt away.

Regarding your initial HIV-acquisition risk, I agree with the infectious disease specialist who advised you that your HIV risk did not warrant PEP and recommended you stop your treatment. Yours is another example of why 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. The HIV specialist will evaluate the actual risk, optimize or discontinue PEP, evaluate and treat any symptoms or side effects that develop during treatment, and arrange for and interpret all post-PEP follow-up HIV tests as indicated. Had you seen an HIV specialist sooner, your PEP would have been discontinued sooner.

Your negative HIV-antibody tests at three and six months are definitive, conclusive and WOO-HOO-able. HIV is not your problem. No way. No how. No additional HIV tests are warranted.

My advice is simple: Stop worrying and start WOO-HOO-ing.

Happy Holidays.

Dr. Bob

Possible Occupational Exposure
another oral sex and PEP question. Would appreciate a response

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