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PEP after condom came off with HIV+ GF and some other concerns
Feb 15, 2012

NI've been on PEP for 3 weeks Combivir and Kaletra. I was having sex with my HIV+ GF, I had pulled out and was doing a couple other sexual things and then I noticed the condom was inside her. I took my first dose around 19 hours post exposure.

I'm also somewhat concerned about some instances in mid-late november and early December. I performed oral sex on her with a couple very small cold sore, a canker sore and quite possibly bleeding gums from flossing my teeth prior to us being intimate on a few different occasions in that time frame. I have this condition exfolitive cheilitis on my lower lip, which I've wondered if it would increase my risk due to perorming oral sex. My dental hygenist noted cuts on my gums in early december from me flossing too roughly.

My GF's viral load at her last test was 15,000. However she told me she was sick when her blood was drawn, so it may have been inflated due to that factor. Another time I pulled out and the condom stayed in her except the base of the condom was still outside her vagina, therefore I felt I wasn't exposed.

Around that time I also fingered her or had my fingers wet with her vaginal fluid before I put some lube on my penis before putting a condom. I know HIV dies when exposed to oxygen however I'm not sure how quick this happens.

1)Is this something I should avoid?

I had Diarrhea in early December that has persisted until now there has been some blood and I've been going up to 10 times a day. I also got a strange illness just after the diarrhea started first I was getting a rash around my neck odds feelings in my front neck area and behing my ear, I ended up with a fever for a few days, intense muscle aches that I've never had before, severe fatigue, loss of appetite. I have this skin condition seborrhea and it got quite flared up. Before the illness went away I got this rash all over my front and back, which my GF said looked quite similar to her HIV seroconversion rash. It certainly worried her except her's was more blue or purple while mine was more red. I also lost 5+ lbs during that illness which lasted just about 3 weeks. I got better except the diarrhea. My appetite slowly got better.

I went to the STI clinic on December 14th(I had been sick for a week at that point). I'm guessing 2-4 weeks post exposure and I got a negative 4th generation HIV test. I also went January 19th 7-9 weeks post weeks exposure and got another negative 4th generation test. This last test was merely days before my exposure that lead me to getting PEP.

2)It's my understanding given I had HIV duo tests it's very unlikely if I had HIV from this previous exposures it wouldn't have been picked up am I correct? I read on here that 2 months conclusive with a 4th generation HIV test.

3)I had been taking 1-2grams a day of Olive Leaf Extract, for overall health and I read that it has anti-HIV effects. Could this have possibly slowed replication down lowering p24 antigen and/or decreasing my HIV antibody response? I read an anecdotal report online where a man stated after stopping ARV due to not tolerating the meds his viral load ended up at 300,000 but after taking olive leaf extract at 2 grams a day for a while it went down to 29,000.

A few years ago when I was experiencing some odd symptoms I had a Igm Level that was just below the reference range. My level was around 0.30-0.35 with a reference range of 0.45-2.50 or in that ball park. I've had really bad sinus issues over the years requiring sinus surgery, and getting allergy shots. My sinus issues actually cause me to gag and cough. There is also a family history of crohn's disease(two immediate family members) which as I understand a low IgM level is related to Crohn's disease.

4)Could this effect my anti-HIV blood tests? I've been told that one blood test with slightly below the reference range of Igm is not clinically significant.

5)I had a lot of blood work done 18 months back and I had a high NK activity it was 350.3 LU with a normal range of 50-300. Could this lower the chances of me being infected with HIV after a significant exposure?

Thank you for taking the time to answer my questions it's very much appreciated.

Response from Dr. Hightow-Weidman

Hello there- My first word of advice would be to continue on your PEP regimen as your risk with your HIV+ girlfriend with an elevated viral load is clear. The best thing that the two of you could/should discuss is whether your GF would benefit from being on ART to reduce her viral load. It appears that you have an active and healthy sex life and while I would certainly still encourage condom use, her having an undetectable viral load would significantly reduce your risk. None of what you described should affect the outcome of HIV tests which should be accurate for you. 4th generation tests should be accurate by 2 months. I've never heard of olive leaf and for that reason I am confident it has no effect on HIV. Take care,

LHW



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