Unprotected Sex on PEP - Risk to Negative Partner?

Question

Hi Damon,

I have been on PEP for 14 days. 1 X Truvada daily + 2 X Kaletra twice daily. I had unprotected oral sex with my negative partner on the 14th day. I ejaculated in her mouth and later realized that she had a cut in her mouth. A minor cut, no noticeable blood. My question is: Is it possible that I infected her and only after that the PEP treatment completely killed the infection in my body? Essentially, I am asking that if I am negative at 3 months mark, is it possible that she can still test HIV positive due to this incident?

Thanks, Sanil

Answer

Hi Sanil, Thank you for writing in!

HIV education and prevention is tricky. On one hand, it's important that people understand that HIV is a virus that can be transmitted under certain and specific conditions. On the other, that message can be misconstrued in a way that results in people thinking that it's easily and casually transmitted. What is the balance between responsibly informing people yet not overwhelming with them with fear?

I don't think anyone has mastered that balance yet. But in the meantime, we have the power to learn about about HIV transmission and the reality of how very rare it occurs. HIV must be transmitted from the mucous membranes of one person directly into the mucous membranes of another, hence why sexual interactions and IV drug use are the most common routes between adults. It cannot be transmitted through hugging, kissing, rubbing genitals.

The question you're asking here is related to oral sex. There is some medical debate about whether this is a possibility or not. On one hand you have a few anecdotal (personal) reports of someone saying they acquired HIV through oral sex. On the other, there is very little evidence of this, and researchers cannot verify that no other penetration or intercourse took place.

Here's what we do know: According to the U.S. CDC the risk of transmitting HIV through oral sex is negligent, or "There is little to no risk of getting or transmitting HIV from oral sex." [https://www.cdc.gov/hiv/risk/oralsex.html]. Even if you were HIV positive and had a transmittable (or detectable) viral load, and even if she had a few cuts in her mouth or in her gums, the possibility of transmitting HIV this way is nearly zero.

You didn't say here why you started on PEP, if you were actually put at risk of acquiring detectable HIV, and how long after the potential exposure you started using PEP. These variables make a difference in terms of calculating your own risk of having acquire HIV in the first place.

Let's say for the sake of argument that you did acquire a detectable load of the HIV virus in your system, and you began using PEP in the appropriate amount of time to prevent it from duplicating and replicating in your system (ideally within 72 hours of the exposure). There is no exact calculation that can accurately tell us if you had a detectable viral load after 14 days of using PEP. At the same time, we know PEP works quickly to prevent the body from becoming HIV positive. And as far as I am aware there are no reports of someone acquiring HIV under the circumstances you are concerned with.

Bottom line: None of this information is as valuable as you and your partners getting tested for HIV. But your worst fears here seem extremely unlikely to reflect reality. I hope this helps you to understand your true risk and make decisions accordingly. Enjoy!

For more information about HIV and is and is not transmitted, please visit our resource page here at The Body: http://www.thebody.com/content/30024/hiv-transmission.html