[Question #5227] exposure and pep help

24 months ago
Yesterday I had an anal sex with another man. We also exchanged oral. I was on top and wore a condom. After about 5-10 minutes I withdrew (no ejaculation) and saw that the condom had broken. The head of my penis was exposed inside of him. I freaked out and we stopped. He told me he is hiv neg and was last tested in summer with no bare sex since then. I told him I am neg. I don’t know him well but he wasn’t overly concerned about the condom break. Scared me. I went to the er and started on Pep three hours after sex. (Truvada 200-300 1 per day and Isentress 400 2 per day). The dr was in a hurry and told me to see my dr and read the cdc site with q’s. I’m terrified. How likely am I to be Hiv + now? How effective is 28 days of pep? Will I get hiv if I was exposed? What tests will I get next? Will I know after 28 days of pep? How long after the event yesterday will I have a conclusive answer? I am frozen with fear.
Edward W. Hook M.D.
Edward W. Hook M.D.
24 months ago
Welcome to our Forum and thanks for your confidence in our services.  I'll do my best to answer your questions and make a suggestion or two regarding next steps.  Your risk for infection was relatively low even before your decision to take PEP and the PEP will reduce your risk still further.  Your partner indicated he was HIV infected and that is likely the case since most people tell the truth and he had managed to avoid infection up until last summer - all of this and his regular condom use make it unlikely that he was infected.  If he was infected, your statistical risk for infection as a top is about 0.1% (i.e. on average there is one infection for every 900-1000 acts of unprotected intercourse.  Your rapid use of PEP makes the risk much, much lower reducing your risk for infection at least 90-95% and probably more.  Thus your risk for infection very, very low.  Following completion of PEP you will have to wait at least six weeks (some experts say 3 months) before a combination HIV antigen/antibody test will be conclusive.

A much faster way to assess your risk is to see if your partner is willing to get tested.  if his test is negative at this time, then you are not at meaningful risk for HIV.

I hope these comments are helpful.  Please try not to worry.  EWH
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24 months ago
Thank you! Does this mean that the pep I’m taking is 90-95 percent efficient? And that fact, in addition to my risk facto (1 in 900-1000), makes this a really really low risk situation? Also, can a viral load test be done after I finish pep so I know sooner than 6 weeks after? I will also try and get in contact with the guy about testing. Thank you so much, dr!
Edward W. Hook M.D.
Edward W. Hook M.D.
24 months ago
Correct. PEP is 90-95% effective when taken as directed for the entire 28 day period.  

There are fewer data on the use of viral load in this situation. Certainly in theory, the viral load would be positive before the combination HIV antigen/antibody test but how much is unknown.  EWH
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