[Question #11035] Urgent Inquiry Regarding PEP and Potential HIV Exposure
17 months ago
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Dear Doctor,I hope this message finds you well. Unfortunately, I find myself in need of your expertise once again due to a recent sexual encounter that has left me concerned about potential HIV exposure.Two hours ago, I was involved in a sexual encounter with a woman I met through a dating app. We engaged in unprotected oral sex twice and protected vaginal intercourse twice, with ejaculation occurring inside the condom both times. There were no apparent issues with the condom's as no leaks seen.The woman, who is from Croatia and currently visiting Dubai, mentioned that she was last tested for HIV two months ago. However, she also disclosed that she has been sexually active with multiple partners, and I have reservations about the reliability of her claim regarding her recent testing.Given the circumstances and the strict HIV rules in Dubai, where a positive diagnosis lead to deportation, I am extremely anxious and considering starting post-exposure prophylaxis (PEP) as a precautionary measure.I currently have access to a generic version of Biktarvy Taffic. a) Would this be suitable for use as PEP? b) Additionally, are there any specific tests I should undergo while on PEP? c) Lastly, in the event that the medication's side effects are severe, is it advisable to discontinue the Biktarvy before completing the standard 28-day course?
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Edward W. Hook M.D.
17 months ago
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Welcome back to the forum, although I’m sorry you felt the need. The encounter you describe was close to no risk for acquisition of HIV. In Dubai most commercial sex workers do not have HIV or other STI‘s. In addition your sex was condom protected which makes it virtually no risk. Similarly there has never been anyone who has been proven to have acquired HIV from receiving oral sex. Finally, if you performed oral sex on your partner, the risk of your acquiring HIV is estimated to be lower than one infection, on average, for every 10,000 exposures. In other words, you would have to perform oral sex on a HIV, infected, untreated, person daily for more than 27 years to expect to acquire HIV.
Given your history, if you had approached me, requesting to receive post exposure prophylaxis (pep) for HIV I would have not agreed to do so. Your risk is not high enough.
In general, the medication you have as well tolerated. Should you experience side effects, since I have already told you that I do not think you need post exposure Prophylaxis, I would suggest you stop it.
EWH
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17 months ago
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Dear Doctor,Thank you for your attention to my previous message. I have some additional details and concerns to share, which I hope will help in guiding your advice.
1- The woman I met is not a sex worker. She resides in Croatia and is currently in Dubai on a business trip.
2-I want to clarify that during our encounter, I only received oral sex and engaged in insertive protected vaginal intercourse. Based on your previous advice, you mentioned that my risk of HIV transmission is relatively low and PEP may not be necessary. However, I have read numerous online articles suggesting that condoms provide an 85-90% protection rate against HIV transmission. This information has led me to believe that there might still be a significant risk.
3-I currently have access to generic Biktarvy Taffic. However, I am aware that it is not FDA-approved for PEP use. Would it still be safe or advisable to use in my situation?
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Edward W. Hook M.D.
17 months ago
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Thank you for the additional details. If anything, they make me even less concerned about the exposure you describe. Statements on the Internet are misleading. Condoms offer more than 95%, approaching 98% protection against HIV as long as they are worn throughout the encounter, and do not break. My suggestions remain the same. If you do, choose to use the Biktarvy , it would almost certainly work to prevent HIV. That said, your risk of infection is virtually zero without it. EWH.---
17 months ago
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Dear Doctor,
I hope this message finds you well. I have a couple of additional queries that I hope you can help me with:
1) Recently, I have noticed a few raised bumps appearing on my body and symptoms of folliculitis all over ( chest, neck, eye lid and mostly legs). I am aware that rashes can be a symptom associated with HIV and STDs, but from my understanding, these rashes typically present in clusters rather than as isolated spots. Based on this, can I reasonably assume that my symptoms are not related to HIV or STDs?
2) I am also seeking clarification on the accuracy of the 4th generation HIV test at 28 days post-exposure. While I understand that the CDC considers results conclusive at 45 days, would a test at 28 days be reliable enough to provide some peace of mind and alleviate my anxiety, considering the specifics of my recent encounter?
Thank you
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Edward W. Hook M.D.
17 months ago
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1. Bumps and rashes are non-specific and in your case, likely reflect anxiety-related hypervigilance. Based on the virtually no risk nature of your exposure, you can safely assume that the rash you have noted does not represent an STI, including HIV,
2. At 28 days, 4th generation tests for HIV will detect more than 99% of recent infections. Once again, you really did not need testing but having tested, your test results are strong evidence that you did not acquire HIV
Time for us both to move on. This thread will be closed shortly. EWH
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