[Question #10141] HİV
 |
25 months ago
|
Hello doctor, I have consulted you before and received some information. I don’t have an active sex life. I'm a homosexual male. I usually have sexual intercourse every 3-4 months. It's been 24 hours since the last suspicious sex. It was a protected sex. (I am bottom and anal sex) But there was a tear in the condom for the last 1-2 minutes and the sex continued in that way. The infectionist said that there is a medicine called Biktarvy that should be taken for 28 days.
1) Should this drug be used before sexual intercourse? Does using it after sexual intercourse provide protection? Because 24 hours have passed since that.
2) When should I get tested if I use this medicine?
3) What are the protection rates after the contact?
4) If I do not use this drug, can I trust the accuracy of the HIV-RNA test result after 12-13 days?
Thank you...
 |
H. Hunter Handsfield, MD
25 months ago
|
Welcome back to the forum. Thank you for your continued confidence in our services.
---
---
Once again you have had receptive anal sex (bottom) with a partner whose HIV status you do not know. My main advice to you is to change your ways: NEVER HAVE SEX WITH ANOTHER MALE WITHOUT FIRST DISCUSSING HIV STATUS AND ASSURING YOURSELF THAT YOUR PARTNER DOES NOT HAVE HIV; OR IF INFECTED, IS ON EFFECTIVE TREATMENT Alternatively, consider routine pre-exposure prophylaxis (PrEP) or post exposure prophylaxis (PEP), which is what your doctor is recommending.
Most important, return to your clinic or doctor immediately and accept the offer to take Biktarvy the next 28 days. This is PEP and it's highly effective in preventing HIV after exposure. However, for maximum effectiveness it should be started within 24 hours of a high risk exposure, and doesn't work at all after 72 hours. I hope you can get back to your doctor within that time. If not within 72 hours, there is no point in taking the drug.
1) This question assumes pre-exposure prophylaxis or PrEP. Anti-HIV drug can be taken continuously to prevent HIV if exposed; or for just 3 doses, starting before sex and two more doses afterward. It's not quite as effective as continuous PrEP, but often more appropriate when risky exposure are infrequent, as in your case. Discuss it with your doctor.
2) If you start PEP within 72 hours, your doctor will advise you on testing frequency. Most likely the advice will be to test soon after completing 28 days treatment, and then at roughly 2, 4 and 6 weeks after the last dose. Following PEP, it takes at least 6 weeks after the last dose to know for sure that PEP worked and you were not infected.
3) PEP is nearly 100% effective if started within 24 hours. There are no good data after that, but probably something like 80-90% effective if started at 48-72 hours.
4) If you do not take the drug, the answer is yes: a negative RNA test at 14 days will be very reassuring, meaning you probably were not infected. However, final testing with an AgAb (4th generation) blood test still will be required at about 6 weeks.
Finally, another option is to discuss all this with your partner and ask him to be tested for HIV. If he is HIV negative, you'll know there was no risk and PEP will not be necessary; or if already started, could be stopped when you know your partner's negative test result.
Discuss all this with the doctor you have seen. Let me know if anything isn't clear. Good luck.
HHH, MD
---