[Question #11048] 28, M, Bisexual

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17 months ago
Potentially risky encounters with an HIV+ guy who disclosed his status only after our third interaction:

1st: Protected insertive anal sex (no condom break), unprotected(UP) receptive oral sex, and insertive fisting (no cuts).
2nd: 2 days later, UP receptive oral sex and mutual fellatio (no mouth ejaculation)

I got scared so I had a full STD testing, with an HIV Ab/Ag screening: all negative results 27-28 days post-exposure.

3rd: A day post-negative results, UP receptive oral sex and insertive fisting (I noticed minimal bleeding from my very dry finger node hours after). He then reveals he's on DOVATO, he blocked me; I don't know if he was undetectable (U=U). 

Distressed about the 3rd encounter (I rule out 1st & 2nd because of the 4th-gen negative test), I'll test again in a month post 3rd encounter. No noticeable/strong symptoms, but stress. Seeking clarity on the actual risk: AM I OVERREACTING?
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Edward W. Hook M.D.
17 months ago
Welcome to our forum. Thank you for our questions. I’m saddened that your partner delayed informing you that he was infected and was unwilling to share whether or not he is undetectable. His anti-HIV therapy, however should be highly effective in preventing transmission.

Your testing 28 days following your first two encounters provides more than 99% assurance that you were not infected at that time. Regarding the third encounter, receipt of oral sex has never been shown to result in transmission of HIV and, similarly, fisting is a form of masturbation, and therefore, very, very low risk if there is any risk at all.  

It’s entirely natural to be upset when your partner has acted in the way this person did. That said, I would assess your risk of having acquired HIV from any of the three encounters you describe as being close to zero and not something to worry about. If you wish to address the Question of possible infection sooner than 4 to 6 weeks following the third encounter, you could seek HIVRNA PCR testing, which will be conclusive at anytime more than 11 to 12 days following your last episode 

I hope that this perspective is helpful to you. EWH.
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17 months ago
Thank you for your response! Since I received negative results from a 4th-gen test, concerns for the 1st and 2nd encounters are minimal. For the 3rd encounter, I will consider testing earlier with HIVRNA PCR if available; otherwise, a 4th-gen test 30 days post-exposure. 

Funny thing: he had initially said he was on PREP, so I asked him to show me his PREP meds last time and to my surprise it was DOVATO. When I asked why he didn't disclose, he claimed DOVATO was prescribed along with other pills as PrEP because his body reject/suffer with normal PREP. But all online sources indicate DOVATO treats HIV+ only.

2 follow-up questions from the above:

1. Can DOVATO + other drugs be used as PREP if prescribed by a doctor? 

2. Is my risk so minimal/almost zero from the 3 encounters that I should stop worrying and just test in a few weeks for the peace of mind? I'm having trouble sleeping, I'm having panic attacks, and I'm starting to feel things like mild muscle/joint pain, pins and needles, but I think it's stress. Plus, I also lift weighs and run, so it may be normal body response to exercise.
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Edward W. Hook M.D.
17 months ago
DOVATO is highly active therapy for HIV. While I am not aware that is been studied for use S PrEP, I would imagine that if taken it would be effective.

You have summarized my advice well. Were I in your place, I would not be worried. I understand that you may wish to test to provide the reassurance that negative test can provide, but I am confident that when you do your test will be negative. EWH.
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17 months ago
Thank you for your response, doctor. You're making me feel more relief. 

To finish with my last available follow question(s): 

1. Do you mean there is a chance that DOVATO could indeed be used as PrEP, even though you are not aware of it; and in such a case, you think that as DOVATO is a highly effective therapy for HIV treatment, it could perhaps work as PrEP. Like other HIV drugs are used as both Prep and ART, e.g., Truvada. 

2. Regarding my 3rd encounter, I would almost discard the receptive oral sex as risk, but I am still very concerned about the fisting, because I had a minimal bleeding from the finger node. I had very dry skin around my nodes because of cold winter temperatures. I don't know if it was bleeding before I performed fisting. But if it was bleeding (though very minimally, not a big open cut), is there still a risk of contracting HIV?
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Edward W. Hook M.D.
17 months ago
As you know, this will be my final response to your questions. The thread will be closed soon after this response.:

As I said above. DONATO has not been tested for use as PrEP.. That said, it is highly active anti-retroviral therapy and therefore I am confident that it would be effective if used in that way..

Regarding fisting, when fisting is occurs in the setting of other sexual activities that might introduce infectious material into the rectum, there may be some risk of HIV. In your case, isolated fisting, without receptive, rectal intercourse, would qualify as masturbation, and therefore remain relatively low risk.

My assessments are unchanged. I hope the information I have provided has been helpful. EWH.
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