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On nPep for possible exposure: is this treatment necessary?

Sep 13, 2010

My situation is a bit odd. I met a guy over the Internet to have sex with. We had an at length discussion about both of our disease statuses and when we were last tested and how often. He also works in the porn industry, so i assumed (rightly or wrongly) he was being open and honest.

We kissed, had mutual oral (no ejaculation in mouths) and I topped him with a condom on, which stayed intact during the entire time. I didn't come while topping him, but he did rub the tip of my penis on his anus after we had sex, so there was likely some secretions I was exposed to. After we were finished I was cleaning up and found 4 prescription medications with a different name on all four than the one he gave me. One of the bottles was Truvada, but there were no other HIV medications I could find. I confronted him and he still maintained he was HIV- and that they were a friend's pills. I asked him to show me something with his name on it to put my mind at ease but he refused and even told me I was being ridiculous. He also told me that the reason he did not ejaculate while we messed around was because he had done so before I got there, which would mean I potentially got his semen in my mouth when I went down on him.

I left his apartment and went to the ER where the doctor and an infectious disease specialist said it was a borderline case and offered nPep if I wanted it. Because of the timing issues for starting nPep, I took it and began my first dose of Truvada about 4 hours after my possible exposure. So far, I'm just a little dizzy and tired, and I'm supposed to follow up with an HIV specialist next week.

I will obviously discuss this with the HIV specialist, but do you think I should stay the course with my Truvada nPep treatment? I know there was risk, especially with the oral and my penis rubbing his anus after we had sex, and I don't know what to believe from this guy, so I'm assuming he is HIV+ based on his reaction and him having Truvada. I guess I'm just wondering if I made a good choice to start Truvada? I know there are risks to the treatment, but the risk of contracting HIV seems greater to me. I also feel incredibly stupid and had. I guess I learned my lesson never to trust what people tell you about there status, and will not be meeting someone from the Internet again.

Any insight would be appreciated. Thanks.

Response from Dr. Frascino


In order to make an accurate assessment as to whether nPEP is warranted or not, I would need to take a more detailed history. I was pleased to read that you are scheduled to meet with an HIV specialist next week. I encourage anyone who has had an HIV exposure significant enough to warranted a course of PEP (or anyone who has been started on PEP by an emergency room or urgent care facility) be evaluated and followed by an HIV specialist.

From the limited information provided, your HIV-acquisition risk is very low. nPEP in situations such as these may be offered but would not be recommended. Your HIV specialist will take a detailed history and advise whether nPEP should be continued and if so whether the regimen needs to be changed or optimized.

Good luck.

Dr. Bob


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