[Question #12345] Made A Huge Mistake - PEP Question

8 months ago

Hi Doctors,

6 months ago i (27 male) made a horrible mistake and had unprotected sex with another male. I was the receiver and did not know his status. the very next day I started PEP and complied with it. 3 months after my PEP I tested negative with several 4th gen tests. However, here is my issue. during the second week of me taking PEP i had unprotected sex with my long-term boyfriend. Questions:
- Is it possible that I could have transmitted HIV to my partner during our sexual intercourse when I was 2 weeks into my PEP regime even though I tested negative my self more than 6 months later?

- Has there been cases where a person gave someone else HIV while they were taking pep, but PEP ended up curing them from HIV themselves?

- I have extreme anxiety and don't know if I should tell my partner so that he can get tested and get medicine. This is causing me great stress?

i reached out to my pep counselor and all she said was "do not worry. you did not give your partner HIV because you never had it". However, she didn't say much about a person transmitting to someone else HIV while that person is taking PEP. I also read so many reddit forums which is giving me conflicting information.

H. Hunter Handsfield, MD

8 months ago

Welcome to the forum. I'm happy to address these straightforward questions. The bottom line is that you definitely do not have HIV and could not have infected your regular partner. Your PEP counselor's response was exactly right.

I'm going to assume both sexual exposures, your one-off event and with your partner, were anal sex -- right? If oral, there was no risk of HIV and PEP would not have been warranted and probably not recommended. To your specific questions:

- "Is it possible I could have transmitted HIV to my partner...?" No, it is not.

- "Have [Has] there been cases...?" Not that I have ever heard, and biologically it is impossible, based how HIV infection is established and how anti-HIV drugs work. Your test results prove you were not infected, but even if that had happened, while taking PEP the virus could not achieve transmissible amounts in blood, semen, or anywhere else in your body.

- "I have extreme anxiety...." All we can do here is assure you that you are not infected and could not have infected your partner. Using that information to address your anxiety and stress is your challenge, not ours. If you remain stressed about despite this advice (and that of your PEP counselor), I would suggest a discussion with your primary care physician or a professional counselor as reasonable steps. I cannot advise you on whether or not to discuss this with your regular partner, except to say it does not matter from the standpoint of HIV infection risk for either you or him. There is none.

As for online forums about such issues, those run by and for people with HIV or at risk are the worst possible sources for objective and helpful information. Reddit is an excellent case in point. I suggest not returning there; ignoring whatever frightening information you might have read; and in the future limit online searching about this (or about any health problem that may concern you) to professionally run or moderated sites -- like this one, or those of academic medical centers, CDC or other public health agencies, and so on.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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8 months ago

Thank you for your quick response doctor, this gave me a lot of reassurance. Below are my follow up questions:

- yes both exposures were unprotected oral sex. Does that change your assessment?

- can you share more about how it is biologically impossible to transmit HIV to someone else while I am taking PEP?

H. Hunter Handsfield, MD

8 months ago

All this worry, and using PEP, for oral sex exposures? Yes, it definitely changes my assessment. Oral sex almost never transmits CDC's estimate several years ago was that if the penile partner has untreated HIV, his oral partner has one chance in 10,000 of being infected, with or without ejaculation in the mouth. In the other direction (oral to penis) the estimate is one chance in 20,000; an, d there has never been a single scientifically proved case of HIV transmitted oral to penis. The one in 10,000 and 20,000 risks are equivalent to daily BJs with infected partners taking 27 years or 55 years before transmission of the virus would be likely.

PEP works by preventing replication of HIV, i.e.u the virus cannot reproduce itself or infect the new host's cells. Therefore, too little virus is present in blood, semen or anywhere in the body to be able to infect another person. However, this is the wrong question: Even if the biological reasons aren't known, it is solid fact that transmission of the virus does not occur to new partners in this situation.

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8 months ago

Thanks doctor. I made a terrible typo. It was *anal sex in both instances.

However, what you saying is even if it was anal sex, the PEP prevented me from building up enough copies of the virus to pass it on to my partner?

Final take aways-

1. Can I put this whole thing behind me and move on with my life?

2. There is no way that my partner could have gotten HIV from his exposure having sex with me?

3. Stay away from forums like Reddit and opt for forums like this or CDC?

4. Those who take PEP, and never become infected cannot possibly transmit the virus to someone else while take PEP?

H. Hunter Handsfield, MD

8 months ago

OK -- anal sex makes much more sense.

These follow-up questions have been answered, or at least the answers are 100% clear from my previous replies.

1. Can I put this whole thing behind me and move on with my life? Yes.

2. There is no way that my partner could have gotten HIV from his exposure having sex with me? Correct.

3. Stay away from forums like Reddit and opt for forums like this or CDC? Correct. Or if you find yourself compelled to visit Reddit or other self-help online resources, whether for HIV or anything else, go in with a health dose of skepticism and try to suss out those who are merely giving opinions or citing non-professional sources for their opinions. And just use a little common sense.

4. Those who take PEP, and never become infected cannot possibly transmit the virus to someone else while take PEP? Correct.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope you're able to move on without any further worry about these events.

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