Dear Dr. Bob,

I hope you are doing well.

I called a male escort were we had protected session. During the session the escort took-off the condom for 3 minutes and we had unprotected sex until (I was receptive anal) i realized that & requested him to put it back. he didn't ejaculated inside me & afterwards i give him oral for few minutes then he mastributed for a few minutes until he finished (very few drops).

Later that night he admitted that he is HIV positive but he is on medication & his viral load is undetectable & his CD4 count is more than 500.

I rushed to emergency (about 5 hours from that encounter) & the doctor gave me kaletra and truvada for 27 days (I have more 15 days until I complete my course).

I am scared to death as the doctor said we can't test until 3 month. I feel that world is collapsing, I stopped going to work.

Please tell me what are the chances that I can get HIV. & How helpful the kaletra and truvada to prevent HIV.

Hello.

Unprotected receptive anal sex does place you at some degree of risk for STDs, including HIV. That your partner is HIV positive increases your HIV-acquisition risk. (He should have disclosed his status before the pants hit the floor. He also should not have removed the condom!) There are, however, several factors that would decrease your HIV risk:

1. The exposure was relatively brief.

2. Your top gun didn't pop his cork inside your butt.

3. Your buddy is on antiretroviral medication, which has driven his HIV plasma viral load to undetectable levels. If this is indeed true, it would very significantly decrease the statistical odds of your contracting the virus. See link below.

4. You began PEP within five hours of your exposure. (A full course of PEP is 28 days, by the way.)

Taking all these factors into consideration, your HIV-acquisition risk is low, but not completely nonexistent. Testing remains warranted. Post-PEP HIV-antibody testing is recommended at both the three- and six-month marks.

Good luck.

Dr. Bob

Treating HIV-Infected People With Antiretrovirals Significantly Reduces Transmission to Partners. Findings Result From NIH-Funded International Study From U.S. National Institute of Allergy and Infectious Diseases May 12, 2011