Back here again with another concern which I could really use some peace of mind on. I am currently travelling for work in New York (I am from the UK) and, one my first night here (on Thursday), I engaged in some brief contact with somebody who happens to be HIV positive. 

For context, I take daily PrEP – I have never missed a dose. The exposure with this person involved deep kissing and I received a blow job from this person. I found out after the incident that this person is HIV positive, but takes biktarvy. He mentioned that he has been undetectable since 2011. What concerns me is this person initially told me he was HIV negative and receives the injection, however, he revealed his true status after I found his biktarvy. 

My questions are as follows: 

1) what are my HIV risks here based on deep kissing and receiving a blow job from this person?

2) due to the time difference, my first PrEP dosage following the incident was three and a half hours later than I would usually take my pills – will this increase my risk of HIV from the exposure/lessen the effectiveness of the PrEP in my system? 

3) I'm so nervous that I took a double dose of PrEP after the incident and another today – will this lessen the effects of my PrEP or was this ok? I know I should be careful here because PrEP can be hard on the kidneys. 

Whilst I know that U=U and I'm protected by my PrEP, I cannot shake the worry around this scenario and could really use some peace of mind. 

Now having read all of it:  You apparently do not know that sex with an HIV infected person with undetectable viral load is entirely safe. Which you apparently understand with your closing comment about U=U. Indeed, many experts advise that the partners of such persons do not need to use condoms; there is NO risk of HIV transmission even with entirely unprotected sex, and without PEP or PrEP. You were not at risk for HIV from the exposure described. Further, kissing rarely if ever transmits HIV; and there has never been a proved case of HIV transmission oral to penis.

To your specific questions:

2) Timing of PrEP dosing? It makes no difference at all. Even if there is real risk of HIV, such variation in dose timing is unlikely to have any effect. But since you were at zero risk, for sure it doesn't matter.

3) I'm so nervous that I took a double dose of PrEP after the incident and another today...  This makes no difference. You were not at risk of HIV, with or without PrEP.

All is well. No risk for HIV, no need for testing, and you can move on with no further worry. I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

 

Just a few formality questions on my part:

Best wishes

When research has been done on PrEP effectiveness, the patients studied were advised about the treatment schedule, and therefore official advice recommends following that schedule. It doesn't mean that other schedules would not work, only that they haven't been confirmed by research. Based on the pharmacology of the drugs used, common sense says that the sort of delay you describe would make no difference.

Indeed you are overthinking all this ("reading between the lines); there is evidence of this in all your previous questions as well. All things considered, you should view yourself as being at zero risk for HIV from the events you have described.

In the 20 years of this and our preceding forum, with thousands of questions from people worried about HIV after a new exposure, not one has yet reported they tested positive. You will not be the first. If and when it happens, surely it will be from a genuine risk and not the non-risky situations you have experienced. 

When you lay it out like that i.e 1 in a billion chance of kissing, without even factoring in the prep and his undetectable status, we can safely assume its a no risk scenario? 

Please bare with me with any repetitiveness noted above – I just like to do one final summary before we end the exchange. All in all, the work that you do on here is excellent and this website acts as not only a reality check, but a great source of information on sexual health.

Yes, kissing should be viewed as zero risk for all practical  purposes.

We have a certain tolerance for requests to repeat our advice for reassurance -- but it isn't infinite! No further replies along these lines, please. We also addressed kissing and other forms of safe sex in your previous thread a few months ago, and maybe in the ones before that. We have a pretty strict policy that repeated questions on the same topic are not permitted and eventually we simply delete such repetitive questions without reply, especially when obviously anxiety driven -- without refund of the posting fee. Please be sure any future questions don't ask the same questions as before. Thank you for your understanding.

That concludes this thread. Best wishes and stay safe.