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Brief Anal Penetration (Dip) and PEP
Dec 20, 2010

Dr. Bob - I have donated before and would love to have this answered. Tried topping first time (protected) but had nicked myself with my trimmer at the base of my shaft about 14 hours earlier; I am circumcized. Condom did not cover that as condom was not long enough. Didnt like topping (quit bottoming a long time ago - isnt worth the condom breakage risk) so pulled out and condom off and engaged in frottage. We both moved in such a way that I slipped in for one thrust (less than 2/3 secs). Went and washed off in the shower. Top of penis was a little sore in one place but no visible trauma. SFCC stated that they have never seen anyone get infected like that and didnt suggest PEP. Went to an HIV specialist who prescribed Truvada for 30 days to stay on the safe side. The specialist feels like after I quit taking PEP that an HIV DNA PCR test will be extremely highly inidicative of my status although stated I need to test out to 3 months. 1) Do you agree my risk is minimal? Even with the nick? 2) Is Truvada an effective PEP medication? I see where people take it with Kaletra (I am taking alone). What is the effectiveness of PEP? Started within 14 hours. 3) Do you agree a negative DNA PCR test at 30 days is highly indicative? Doctor said viral load would be suppressed by Truvada but DNA would still be affected.

Response from Dr. Frascino

Hi,

1. Your HIV-acquisition risk was low, but not nonexistent.

2. Yes, Truvada is a recommended two-drug PEP regimen. Some HIV physicians recommend a three-drug regimen, particularly for significant HIV exposures. There are no effectiveness statistics for PEP, as many variables exist among cases. We do know that it helps prevent HIV transmission, but is not 100% effective.

3. The post-PEP HIV-testing guidelines recommend HIV-antibody testing at four to six weeks, three months and six months from the date of exposure. Certainly a negative/undetectable qualitative HIV DNA-PCR would be encouraging, but I would suggest you follow the recommended published guidelines.

Good luck.

Dr. Bob



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