[Question #3294] PEP Doubling as PrEP?

38 months ago
Doctor, I had a risky exposure with a transsexual commercial sex worker in NYC I met on the Internet (condom broke during anal sex, I was the insertive partner) and was prescribed PEP - truvada and isentress, which I started 24 hours after exposure. I am 18 days into the course of treatment andhave taken all doses as prescribed. Yesterday I had a second potential exposure with another transsexual commercial sex worker I met on the Internet, the condom slipped off in her anus. I am not sure whether it happened during the sex. I am also unsure of her HIV status. Being as I am currently taking PEP, assuming she is HIV positive would I be protected from this exposure - would the course of Truvada have acted as PrEP in this instance; or should I seek to extend PEP another 28 days from yesterday? I have ten more days of PEP left, but 12 Truvada pills left. I plan to take all the remaining pills and finishing the full 30 doses as prescribed. I’m once again very worried. Thanks for your help!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Welcome to the forum. Thanks for your question.

Yes indeed -- you were fully protected. The identical anti-HIV regimens aren't necessarily used for PEP and PrEP, but either one would be fully effective for either purpose. You need not continue any treatment beyond the 30 doses of your PEP prescription. However, given that this is your second risky exposure in under 3 weeks, I would assume other such exposure might be likely in fhe future. If so, you should be on PrEP anyway. Discuss it with your PEP provider or, if that doctor or clinic is not an experienced HIV/AIDS provider, establish such care and ask about PrEP.

I'm glad to see that you're using condoms consistently, at least by intent. Even if you seek and continue PrEP, I would encourage you to continue consistent condom use to protect from other STDs.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

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38 months ago
Thank you Dr. Handsfield, I will certainly take your advice under consideration and look into PrEP once I’ve completed this course of PEP. Regarding the timing of follow up testing, when should I plan on getting retested, and when can I be confident in the negative result? That is if it does indeed come back negtive, as I’m hoping!!

I appreciate all your help! 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Thanks for the thanks; I'm glad to have helped.

People who receive PEP need HIV testing at 3 months (and some experts recommend 6 months), rather than the standard 6 weeks with the duo (4th generation) HIV tests. That's one of the main downsides of PEP:  if it fails, it may take 3-6 months to know. So the period of anxiety until definitive testing is much longer than without PEP. It's one of the main reasons PEP should be done only for truly high risk exposures. In any case, you should discuss follow-up testing with the doctor or clinic who prescribed it.

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38 months ago
Got it, thanks Doc. Have a great rest of the weekend. 
38 months ago
One final question, in your experience how many patients have you seen that have had similar situations (condom breaking, insertive anal, starting PEP within 24 hours and completing the full course) where PEP has failed? I know you cannot provide any definitive answers, stats or anything like that and that every situation and outcome is unique; but I am just curious as to your personal experience in seeing the outcome of similar situations so that I can be realistic with myself and better understand the level of concern I should have. As you said, given that PEP extends the window period of accurate testing I am sure you can imagine my anxiety level. Again, thanks for the amazing service Dr. Handfield. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
This has never happened in my experience. But my personal experience makes no difference. Rare things happen. I've never cared for a patient struck by lightning, but obviously that has no bearing on your risk of it happening. (Don't golf during a thunderstorm -- and if you do, don't point your 9-iron at the sky!)

But perhaps it will interest you to know that in the 14 years I have been doing this and an earlier online forum, with thousands of questions about HIV risk after various exposures, nobody turned out to have been infected. You're not likely to be the first.



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38 months ago
Point well taken! Thanks for all your insight and help Doctor Handsfield!