[Question #4282] PEP

29 months ago

Hi there. I had protected intercourse with a massage worker. During the intercourse 2 time I took out my part and saw the condom is there and safe. I ended up coming inside her. But when I took my part out of her I saw my cum inside her vagina and the condom broke (The time that exposure ended was 11:35 AM). I freaked out and she said she is clean and those stuffs but who knows. I immediately go to doctor and she gave me PEP which is 2 medicines (TIVICAY 50 MG and TRUVADA). I start taking these two 4 hours and 30 minutes after my exposure( at 4:00 pm the same day).

I have 2 questions.

(1) Is it possible that PEP actually give or cause me HIV virus? (I know its silly question, but just want to know?)

(2) Do you think is there any chance that if she had HIV virus and if I catch the virus, I might get clear after 28 days? because I read in internet and I see everyone saying its a might, its not effective 100 percent and you might ended up positive.

Thank you.

H. Hunter Handsfield, MD

29 months ago

Welcome to the forum. Thanks for your question.

My first reaction is to congratulate you for using a condom for this event. It failed, but your intent was good. My second thought is to question whether PEP really is necessary in this situation. If it is known that commercial sex workers in the area where this occurred have a frequencies of HIV, then PEP probably was reasonable. If you would like to describe where this event occurred I might have more comments about the risk you were infected with HIV and need PEP.

In the meantime, responding to your specific questions:

1) The anti-HIV drugs cannot give someone HIV. No worries at all about this.

2) There are no data on the exact effectiveness of PEP. However, all available information indicates it is highly effective, with no realistic risk of being infected. You can be certain that if you take PEP as directed for a month, you definitely will not be infected with HIV.

Let me know if these answers are not clear. In the meantime, I hope this information is helpful.

HHH, MD

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29 months ago

Dear Dr. Handsfield,

Thank you for reply. It happened in the east of LA, the city of Rosemead or Ahalambra. The lady was an Asian lady. Of course we cannot say by the look or race that if the person is infected. But from one side, I am reading the side effects of PEP that how much health problems they might create for me, on the other side, I am thinking what if she was positive? It was my bad luck that my condom broke and I actually came into her vagina. I really don't know should I continue the treatment and accept the side effects and mental health issues that will happen t me in the future or I should discontinue the treatment.

H. Hunter Handsfield, MD

29 months ago

Hmmm.... I don't want to overtly disagree with the doctor you saw. But frankly I don't see why PEP was prescribed. The chance your massage parlor partner had HIV is probably less than 1%, maybe only 1 in a thousand. If she did, the chance you were infected was at most 1 chance in 2,500 (equivalent to unprotected sex with infected women once daily for 7 years before transmission might be likely). So your risk of HIV calculates to be something around 1 chance in 250,000 or maybe as low as 1 in 2.5 million.

There are no side effects to worry about. PEP is very safe, regardless of what you may find on line. And PEP does not cause "mental health effects". That's not the issue. However, there is another problem you should consider. If PEP doesn't work, it might increase the window period for testing. Without PEP, you could have conclusive testing 6 weeks after exposure. With PEP, most experts recommend extending the test period to 3 or even 6 months. So instead of being anxious 6 weeks until your negative test, it will be 3-6 months.

If somehow I had been in your situation, I definitely would not take PEP. However, you should not stop treatment on your own. I suggest you discuss these issues with the doctor who prescribed it, and then decide together whether or not to continue it. You could print out this thread as a framework for discussion with her.

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