[Question #12512] Exposure with a POZ person

7 months ago

Hi Doc,

I had an exposure with a positive person today. We had unprotected anal sex whereas I am the TOP. He admitted it to me after we did but he assured me that he is UNDETECATBLE for 4 years now. He even showed me his med certificate that says UNDETECTABLE and also showed me the meds he is taking which are Ricovir-EM and EFAMAT. In addition I am currently on DAILY PREP without missing a single dose for 9 months now.

1. Is this something that I should be worried about? And what Are the chances I'll catch HIV?

2. How Effective is PReP on this matter?

3 Is HIV AG/AB a 4th generation type of test( This is what it says on the Lab forms everytime I need to get tested to get PReP medication)?

4. How soon should I get tested for peace of mind and that has an acceptable result, because I can't wait to get tested?

Please help me because im still in shock and I can't think logically. All I am thinking is that I will get HIV.

H. Hunter Handsfield, MD

7 months ago

Welcome back to the forum. However, this question is almost identical to the one you asked three years ago (question 8428) which also followed sex with an HIV infected person on anti HIV treatment and with an undetectable viral load. The answer is the same: such persons cannot transmit HIV, no matter what kind of exposure you have with them. When a monogamous couple includes a person without HIV and an infected partner on treatment with undetectable load, the advice to them is that condoms are not necessary. You taking PrEP would itself be 100% protective even if your partner had untreated HIV. (All this has even been integrated into routine prevention messages from CDC and others: U=U, i.e. Undetectable equals Untransmittable. Your risk was zero and you don't even need testing for HIV. Therefore:

1. No worries and no chance you could be infected.

2. PrEP is considered 100% effective, but makes no difference in this case.

3. Most doctors or clinics that prescribe PrEP do require periodic HIV testing, but you'll need to check with your own doctors on this.

4. As I said above, you do not need testing on account of this event. Just follow whatever guidance your doctor suggest about testing as part of your PrEP regimen.

There is no rationale to be "in shock". Regardless of the "shock", it is your responsibility to think logically anyway. Just do it.

I hope these comments -- having now had our identical advice two times -- take care of your concerns. Let me know if anything isn't clear.

HHH, MD

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