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Risk Assessment

Jul 20, 2010

Dr. Bob,

I'm HIV poz and my partner is neg. We've been very careful until tonight. We were sleeping and he was knocking at the back door. While still half asleep, I let him penetrate me unprotected. After, I noticed some blood on the toilet paper--just small spots. He didn't have any visible blood on him. I don't believe it came from inside; I believe it came from around the anus. I always wipe too hard and get chapped down there. I feel embarrassed for talking about my anus and stupid for having unprotected sex. Okay, I know there is risk here and I know you can't say how much. I'm just wondering how docs decide when PEP is warranted? I'm not on meds yet and my vl was 9,000 last checked. It has been that level for over a year. I know I've been infected for several years prior to knowing my status. During that time, we had lots of sex and he remained neg; however, I can't remember ever seeing any kind of blood.

Response from Dr. Frascino


PEP would be warranted for the situation you describe and should be started as soon as possible after such an exposure. Unprotected insertive anal sex with a partner confirmed to be HIV positive, who is not on combination antiretrovirals and has a viral load of 9,000, would certainly qualify as a significant HIV exposure. That you noticed some rectal bleeding would further increase the transmission risk.

You and your partner should review the information in the archives chapter devoted to magnetic couples. Also in the archives you'll find information pertaining to PEP, HIV-transmission statistics, HIV-sexual transmission and a number of other related topics.

Good luck to you both.

Dr. Bob

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