[Question #12568] Daily PreP / ARS Symptoms / Attempted to Bottom?

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7 months ago
On Dec 27th, I attempted to bottom.  I take prep daily and have done so for months, and can count on my hand the number of times I've missed a dose, I had at least 7 days of prep in my system before we met.  I briefly attempted to bottom but had to stop after a few seconds due to him causing me to have an anal fissure.  We decided to stop and I topped him.  Nobody ejaculated inside anyone.  On Dec 31st, I also then unrelated to this got two vaccines (Flu and Tdap) and noticed lymph node groin swelling, but it was also coinciding at a time where my fissure was quite bad.  Jan 5 - Jan 7 I had a mild fever (37.7), had one night sweat on the last night into Jan 8 which broke my fever, but no other symptoms (no other node swelling, no rash, no aches, etc). Groin returned to normal.  I texted the partner to ask what testing he had done and if he's on prep.  He stated he's on daily prep and was tested in early December as part of his regular re-supply of prep meds. 

My questions are:
1.) How likely of an event is this considered high risk.  In terms of risks would you be particularly concerned based on my prep adherence and the event itself?
2.) How likely if he did test negative, that is was a false negative and that he's actually positive for HIV while taking prep 
3.) How likely if he did have HIV that it was a prep resistant strain and bypassed my prep?
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H. Hunter Handsfield, MD
7 months ago
Welcome to the forum. I'm happy to address these issues.

Nothing in your description of your sexual contact or symptoms should be alarming. There is no chance you acquired HIV and low chance for any STD. Congratulations for using PrEP and carefully complying with the program. To your questions:

1) There are no formal definitions of low versus high risk sex. What some consider high others might consider to be trivial risk. But with both of you on PrEP, I would put the chance of HIV at zero -- and of course zero is as low risk as you can get.

2) It's virtually impossible to acquire HIV while on PrEP (with good compliance) and in any case nobody with negative test results is likely to transmit HIV. You can trust your partner's negative HIV test result.

3)  In theory, HIV resistant to commonly used PrEP drugs, but so far this is exceedingly rare if it occurs at all, especially in the US, Western Europe, or other industrialized countries. This possibility shouldn't worry you at all.

I hope these comments are helpful. Let me know if you have any further concerns.

HHH, MD
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7 months ago
Ah ok. That makes me feel better/a bit relieved!

Even if he was lying or misinterpreting his results and he was somehow positive and or detectable, does the story change especially for 1?
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H. Hunter Handsfield, MD
7 months ago
Even with known and confirmed HIV infection, the chance of transmission from a single episode of aborted anal sex, i.e. with minimal or no actual penetration, would be no higher than one chance in thousands. Anyway, it's pointless to speculate about unlikely scenarios:  the fact is that there probably is no realistic chance your partner was lying or could misinterpret his test results. So the answer is no:  "the story" would not change.---
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6 months ago
Ok got it.  I guess the anxiety was also due because when I've tried to find incidences of prep efficacy I've seen details on like 99% in clinical, 86% in real world, but sometimes lower?  And sometimes they state the number is lower because of people's improper dosing, and that if taken directly it is exceptionally rare for the failure to occur?

Any final clarity on that would be super helpful as my final comment/question on this thread.  Thank you!
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H. Hunter Handsfield, MD
6 months ago
"Real world" use takes human error into account, exactly as you suggest with your comment about improper dosing. It's similar to biological effectiveness of condoms versus "use effectiveness":  for pregnancy prevention, these are nearly 100% versus 90%. Human nature being what it is, for every hundred people prescribed PEP, obviously some (maybe around 14%?) forget doses, never fill their prescriptions, are spaced out on drugs, and so on. The 99% figure (or 100%) applies for someone who is careful to stick with the program, as you have done.

As you anticipated, that concludes this thread. I hope the discussion has been helpful.
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