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Sero discordant couple. Prevention
Jan 7, 2011

Hi doctor

I am man, positive for 3 years and my present CD4 is 825 and viral load is undetectable.

My partner is HIV -ive female as per test results of last week.

We are very active in sex. And we indulge in foreplay that includes oral sex and penis entering vagina without condom for short while. We are not able to avoid this kind of foreplay though we tried to control.

My questions are :-

Should my girl friend start prophylaxis treatment. If yes then which medicines she should take and the dosage and period for this medication.

Should she start medication within 72 hours after we have any incidence of condom tear or full intercourse without condom if so then which medication and dosage she should take.

Regards

Response from Dr. Frascino

Hello,

I would suggest you and your partner read through the information in the chapter of the archives of this forum that is devoted to magnetic couples. You may wish to consider some of the harm-reduction strategies discussed there.

Responding to your specific questions:

1. PrEP (pre-exposure prophylaxis) has recently been shown to decrease the risk of HIV transmission in men who have sex with men. Presumably it will be similarly effective in heterosexual couples, although those studies are still ongoing. PrEP, when used, is not a substitute for latex condoms, but rather used in addition to condoms. You can read more about PrEP in the archives. The medication used in the clinical trials was Truvada.

2. If you have an accidental exposure, your partner should begin post-exposure prophylaxis (PEP) immediately. You can read much more about PEP in the archives as well. Regarding which medication to use, you should talk to your HIV specialist. He will provide a starter pack of medications for her to take immediately in case of an accidental significant HIV exposure. She should be seen by an HIV-knowledgeable doctor if she starts PEP for further evaluation and management and to get a prescription for the remainder of the 28-day course of treatment. There are a number of recommended PEP regimens from which to choose.

Dr. Bob



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