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sex with an hiv+ man, PEP started outside 72 hour window
May 15, 2010

Dear DR. Frascino I recently and stupidly had unprotected sex with a man almost 2 weeks ago; it was rather brief n mild, I was insertive, I used a lot lube, I did ejaculate, and I don't recall any blood on my penis after washing up. 4 days after the encounter I found out that he was hiv+... after his yearly hiv test. I immediately went to an HIV clinic and was started on PEP after a hiv- baseline. I have been on PEP for 1 week now and while my only side effects seems to be heartburn, headaches, and mild chest pain/ possibly related to the chest pain/ epigastric. I was told to give PEP a try because there is no data that states it is 100% ineffective outside the 72 hour window. Should I continue PEP, or is it pretty much assumed that PEP is not doing anything? What if his viral genotype is resistant to the PEP meds I am on? I know I must get tested at 1 month and 3 months but by taking the meds; if I am infected am I only delaying the infective HIV process (the acute stage and a possible false negative at 1 month), or is the medication preventing the virus from permanently "setting up shop"?

confusedly yours, -M-

Response from Dr. Frascino

Hello M,

I agree unprotected sex was anything but a wise decision and does place you at risk for STDs, including HIV.

I disagree with the decision to recommend PEP four days after an exposure, based on what we know about HIV pathogenesis. I would advise you discontinue PEP.

HIV testing post-PEP (or after a significant HIV exposure) is recommended at six weeks, three months and six months. You can read much more about PEP, HIV diagnostic tests and related issues in the archives of this forum. Have a look!

Good luck.

Dr. Bob



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