Please answer!!!

Question

Dear Dr. Frascino, please, please answer my qn!!! I have had unprotected sex (quite rough) with a person who is HIV(+) but is currently on meds and has undetectable viral load. I was denied PEP in ER. What is theoretical and practical infectivity of a virus that is "poisoned" with antiviral drugs in the carrier? I am really scared!!! I will generously donate to your foundation!!! Please answer my question!!!

Answer

Hello,

The estimated per-act statistical risk for acquiring HIV from unprotected sex with a partner confirmed to be HIV positive depends on the type of sexual exposure (and other factors). The CDC has published statistics for receptive and insertive anal sex, receptive and insertive penile-vaginal sex, and receptive and insertive oral sex. These statistics give a good indication of the relative risk of one type of activity compared to another. For instance, insertive oral sex is much less risky than insertive vaginal sex which in turn, is less risky than insertive anal sex. However, there are many other variables that come into play when considering HIV transmission. These include viral factors (viral strain, viral load, etc.) and host factors (concurrent STDs, immune integrity, trauma, etc.). There is no doubt that being on effective combination antiretroviral drugs that suppress the HIV plasma viral load to undetectable levels significantly decreases the risk of HIV transmission. However, it does not completely eliminate the risk. Whether to recommend PEP is a judgment call based on all these factors. Often in situations like yours, PEP may be offered but may not be strongly recommended.

HIV-antibody testing is warranted at baseline, three months and six months.

Thank you for your donation to The Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's very much appreciated. In return, I'm sending you my good luck/good health karma that you are now and will always be HIV free.

Good luck. I'm here if you need me, OK?

Dr. Bob