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HIV prevention and Truvada alone as PEP
Jun 17, 2011

Hi Sir,

I truly appreciate your kind help on listening and answering my problems. I apologize in advance should my questions have already been answered and cause any inconvenience for you.

My situation is as follows:

1. My female partner used my penis to rub against her vagina and the tip of my penis (only) might slip into her vagina for a bit.

2. Then I put on a condom. She performed oral sex and then rubbed my penis against her vagina. Then I pulled the condom off.

3. After a while, I put on the "same" condom and had an intercourse with her together with the use of baby oil.

4. The intercourse continued for about 5 - 10 minutes. I then checked the leakage of the condom by pouring tap water into it full. I saw no leakage. When I pulled it off the condom still sticked to my penis but up from the base of my penis (around mid penis).

5. I was prescribed with Travuda as the only drug for PEP. I had the first pill within 3 hours of the exposure.

My questions are as follows: 1. Even without PEP, is my situation considered to be high risk of getting HIV?

2. The health counsellor told me that my situation doesn't warrant PEP as the situation is considered very low risk. Is this correct?

3. I insisted for PEP so I was prescribed with Travuda as the only drug; however, I have heard that Truvada has to be taken with other drug to make it effective. So is Truvada alone effective for PEP?

4. Can I do blood test right after the end of PEP (I was prescribed 30 pills of Truvada)? If yes, how reliable? And what test I should opt for? The counsellor mentioned something named 4th Gen. Is the test from 4th Gen reliable right after PEP reliable? I may not have time after the PEP end as I may have to travel for an extended period. So, I hope the test from 4th Gen after PEP is trustable.

5. Has there ever been any incident that the person who was tested negative by using the 4th Gen method right after his/her PEP...becoming positive in later tests?

6. I had the first pill of Truvada at 6.30pm; however, I would like to change the taking time to 10pm. So the counsellor told me to have the 2nd pill at 7am the next day and the 3rd pill at 9pm the same day. Then, I can continue my regime at 9pm until the end of PEP. Is this the correct method? And will it reduce any efficacy of PEP?

7. What other STDs can I be infected given my situation? For each STD mentioned, at what risk?

Response from Dr. Frascino

Hi.

You don't mention the HIV status of your partner. I'll assume she's confirmed to be HIV positive.

1. No.

2. Yes.

3. Yes, Truvada is a combination of two antiretrovirals and can be used for PEP. In some cases a three-drug PEP regimen is preferred.

4. The guidelines for post-PEP HIV testing recommend HIV-antibody testing at four-to-six weeks, three months and six months.

5. Testing right after PEP is not recommended.

6. You can change the time of your Truvada dosing directly from 6:30 PM to 10 PM without concern about compromising efficacy.

7. There are a variety of STDs that are possible. I would suggest you get a routine STD screen.

Dr. Bob



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