HIV transmission from a "Bottom" to a "Top"
Nov 2, 2010
Hi! Im not sure how to ask this so I'll just start from the beginning.
I had sex with someone on friday (10_22_10) with someone I was seeing for approximately 4-5 weeks and had yet had sex with him. I am 21 and he is 23. I was told he was HIV negative and believed him. As it turns out he was not. He told me after we had partial sex. We didn't use a condom. I was the top and he had bottomed We had some oral and penetrative anal sex. Neither of us had climaxed. We had actually stopped mid session for a reason I do not know. After we cleaned ourselves he had informed me that he was HIV positive. I FREAKED OUT! i essentially had a panic attack and dragged him to the hospital with me. I went to the hospital because I had never experienced something like this before, and still quite worried. At the hospital they had drawn blood and contacted a specialist in diseases. Once they came back with my blood tests - which was tested via the rapid HIV test. it was negative (however, this does not mean anything since the test tests for antibodies your immune system creates; which - I've been told - can take up to 3 months to become detectable) They also gave me 3 pills. 1 - 500 mg Combivir and 2 - 250mh Kaletra pills. Are these effective?
So here are my multiple questions. I have previously read on here that the statistical data for a bottom to transmit HIV to a top can be estimated at 6.5 per 10,000 (unprotected). It is however, naive to entirely put my trust into a statistic but I can hope i am one of those individuals whom do not contract HIV. Are these statistics accurate? Does the fact that they gave me a 3 day supply of the before mentioned medication help me in this case? and if so, how? I am also going to speak with the primary care physician of the man who has been tested positive. What are some options they may give me? Are there any options?
I am absolutely horrified.
Response from Dr. Frascino
You broke both of Dr. Bob's cardinal rules for staying well:
Cardinal Rule #1: Assume all sexual partners could be HIV infected and take all the necessary precautions to prevent the spread of HIV.
Cardinal Rule #2: Always remember Cardinal Rule #1!
You report you freaked out only after your bottom boy advised you he was virally enhanced. What if he didn't disclose his status or maybe didn't even realize he was infected? Would you be at any less risk for contracting HIV? No, of course not. Remember, one out of five HIV-positive folks in the USA (which has well over 1,000,000 HIVers) has absolutely no idea he or she is infected with the virus!
The statistic you quote is an estimated statistical risk published by the CDC. However, you cannot apply this estimated risk to a specific sexual coupling, because there are many confounding variables involving both the virus (viral load, viral strain, etc.) and the host (immune integrity, concurrent infections, local trauma, etc.). The bottom line is that you put yourself at risk for STDs, including HIV, and need to be tested.
PEP (post-exposure prophylaxis) involves taking antiretroviral drugs shortly after a significant HIV exposure to help abort an infection. The sooner the first dose is taken, the better chance PEP has to work. PEP is not felt to be helpful or worthwhile when more than 72 hours have lapsed between the exposure and first dose of medications. Your PEP regimen, Combivir plus Kaletra, is a recommended regimen. The three-day supply is only a starter kit. A course of PEP requires a full 28 days. You can read much more about HIV risk, diagnostic testing and PEP in the archives. Have a look. I would also encourage you be followed by an HIV specialist during your course of PEP and for the post-PEP follow-up tests out to six months.
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