Prep, Oral Sex, Recently Seroconverted Partner

Question

Hello.

I started taking prep (Ricovir EM) about 5 weeks ago after having a discussion with my GP. I am a gay man who has sex with other men.

I learned today that a partner I had receptive oral sex with 12 days ago got very sick with flu like symptoms the day after we met up and tested positive this past Friday for HIV.

Should I be concerned about this? I understand that oral sex risk is quite low and being on Prep (3 weeks at that point) cuts the risk too, but his viral loads were probably incredibly high at that time.

Should I be worried?

Thanks so much.

D

Answer

Hello -- Thank you for writing in about a troubling and anxiety-provoking event.

In order to decipher your risk, let's break this down point-by-point:

(1) You state you were on PrEP for 3 weeks before this exposure to detectable levels of HIV. The good news here is that daily use of PrEP for 7 days or longer reduce the possibility of acquiring HIV if exposed by at least 99% (http://www.natap.org/2016/ICAAC/ICAAC_02.htm). There are at least 200,000 people in the world using PrEP right now, and only 3 have reported acquiring HIV while using it as prescribed. In the U.S. and the UK, new HIV rates went down significantly during the time frames that PrEP usage went up. That, plus the initial efficacy trials, tells us that PrEP works extremely well even when someone is exposed to detectable levels of HIV.

(2) Even without PrEP, the possibility of acquiring HIV from receptive oral sex are still exceeding low - about .04% (https://www.poz.com/article/HIV-risk-25382-5829). Oral sex is not considered a high-risk activity, and rarely has been associated with HIV acquisition.

So if you take that .04% and divide it by 99% from PrEP, you see that your risk of acquiring HIV are about .0004%. Depending on where you live, you are actually at much higher risk of getting shot or getting hurt driving a car or getting struck by lightning than getting HIV from oral sex (http://www.motherjones.com/politics/2014/12/gun-violence-car-deaths-charts/).

I can't tell you how you "should" feel, as "shoulds" are obsolete in emotional care. But I can tell you that the facts point out that you are at nearly zero risk of having acquired HIV from the experiences you shared, and probably could do yourself a great favor by relaxing, continuing on PrEP, and being a source of support to your friend going through this life-changing event.