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Issued 2 drug regime only.
Jul 22, 2013

I tired to ask a question here earlier but dont think I did it right. Will try again. Here goes.

I made a huge error and had unprotected anal receptive intercourse with a man who said he was negative when under the influence of alcohol. He did not ejaculate inside me though I know it is still high risk activity. This is not normal for me. It didn't feel right and I went to see the doctor the next day and started PEP (Truvada only) approximately 19 hours after exposure.

I received a text message around 5 days later from the guy saying that he was showing symptoms of acute infection and sure enough he tested positive a few days later. This has stressed me to no end. I understand this will mean he had a high viral load and therefore will be more infectious. I contacted my doctor after doing some research to see if I could have a third drug added to my regimen but it was over a week at this point so I wasnt able to. I am really disappointed I wasnt started on 3 drugs to begin with. The doctor did try to assure me that 2 drugs is still thought to be very effective and it is a good sign that I started the medication within 24 hours. I am not sure if she is just trying to make me feel better, from what I have been able to read, most people get 3 drugs for far less risky exposure. Feeling like the odds are against me at this point and highly concerned my PEP regime is insufficient.

Anything suggestions on things I can do at this point or advice would be appreciated. I am quite frightened. I really hope 2 is still effective, nearly everywhere I have read has suggested it will be (with the exception of one post on this forum which suggested it may not be that has added significantly to my stress). Oh genuinely thanks for all the advice and time.

Response from Dr. Wohl

Part of the problem with the archaic and ill conceived PEP recommendations for occupational exposure is that it has led to confusion when it comes to PEP following sexual exposure. With occupational exposure, outmoded guideline do indeed offer two drugs if exposure was not too risky and three is really risky - this of course makes no sense and many have long abandoned this to a standard three-drug regimen in all cases.

For sexual exposure, three drug therapy has been the standing recommendation. Share the link with your doc and teach her something:

http://aidsinfo.nih.gov/contentfiles/NonOccupationalExposureGL.pdf

At this point you are likely done or close to done with the 4 week course and the question of whether to add a third agent is moot. There is some solace in that there is no clear evidence that three drugs beats Truvada as PEP after sex, it is just the opinion of experts. Animal data shows efficacy of Truvada as PEP and it clearly does do something.

Next step is get tested after PEP and then again at 12 weeks. Use of a p24 plus antibody assay will provide better assurance and is preferred here.

DW



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