[Question #8528] HIV Risk, Recommend PEP?

43 months ago

I got very drunk, got home very late. I live downtown in a big city where it’s cold. A young male outside of the complex approached me, I think he was asking for money (I don’t remember completely). But it was freezing cold outside, so I let the guy inside so he would be warm, I think he was homeless. But I think I do remember this guy saying he’s HIV positive. Maybe he was asking money for treatment? I don’t remember, I was so drunk that my ability to recall everything from that night just isn’t there.

Anyways, I woke up in the morning and this man was on my floor asleep. I’m not homosexual so even blackout drunk I don’t think anything happened. But what if he tried something? This is a homeless man that I don’t know. He was nice in the morning and left quickly. I had all my clothes on, even my belt on. No pain in the buttocks region. So the potential that something happened is low. Also, I’m uncircumcised so I know that could raise the risk if something did happen. Obviously, sober I wouldn’t let a stranger stay at my place.

My question is, based on everything I’ve said would you recommend PEP? This would’ve happened probably over 30 hours ago.

Also, what are the drawbacks of PEP? I have food allergies but I’ve gotten it very under control. I don’t know if it would be worth the side effects, but obviously it would if something for sure happened. Do you know if it’s gluten free?

Do I need to deep clean my apartment after someone that was HIV positive was here? Is that necessary?

One more thing, how effective would PEP be after 72 hours?

Thank you.

Edward W. Hook M.D.

43 months ago

Welcome to our forum and thanks for your question. I will provide my specific answers immediately and then provide you with the rationale behind them. If you had approached me in my clinic requesting PEP, I would not be willing to prescribe it. The medications are expensive, there are occasional side effects, and there is certainly no medical indication for prescribing it. Similarly, I see no reason for you to take special precautions around your home including special cleaning. HIV is transmitted only through unprotected sexual exposure or injection of infected material deep in the tissue.

Scenario you describe makes it unlikely that any sexual activity occurred. Why would a person to whom you were acting as a good Samaritan, undress you, sexually assault you, then dress you again in a manner which provided no evidence that you had been assaulted. Further, there’s a person who has never had anal sex before, if you had had it you would know it.

I would really not worry about this encounter and complement you on your kindness to others. If there are further questions or you desire clarification regarding any of the information I have provided, please don’t hesitate do use you were up to two follow-ups for that purpose. Please don’t worry. EWH

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Edward W. Hook M.D.

43 months ago

I would add that in nearly 40 years of taking care of persons with and at risk for HIV, I have never seen nor heard heard of a person being assaulted in the way that you suggest. I am confident you will not be the first. I see no scientific reason for concern and no reason for testing. EWH---

43 months ago

Thank you for your prompt response! Since I do have two follow-ups, I would like to ask a couple of additional questions.

1) It is very cold, and my hands get very dry. I do have several cuts on my hands and my hands even bleed. Would there be any additional risk because I think I do remember shaking his hand? Since I have open wounds on my hands.

2) Is PEP effective at all in prevention after 72 hours of suspected exposure? Would just like to know if you have any numbers of percentages on that. Would you know when it is completely ineffective? Would just like to know in case I change my mind.

3) As far as testing goes, are there any test that would get me a very quick answer? The fastest I’ve seen is 11-14 days after exposure, RNA test from my research.

Thank you.

Edward W. Hook M.D.

43 months ago

Thanks for your follow up questions. I’ll go straight to my replies:

1. The cuts on your hand, even if they were relatively fresh, would in no way change the risk calculation. Still no risk, no concern situation. Interestingly, Persons with cuts on their hands and fingers are Still at no risk for acquisition of HIV when they engage in masturbation of an HIV infected person and get genital secretion on their hands, even if cuts are present.

2. PEP is more effective the sooner it is started. It is considered to be ineffective 72 hours after exposure.

3. The information you have found is correct. The earliest reliable testing for HIV would be accomplished at 11 to 14 days following exposure using an HIVRNAPCR test. Even when the HIVRNAPCR is used, perhaps out of conservatism, most experts would recommend final, follow up testing at 4 to 6 weeks using a fourth generation combination HIV antigen/antibody test. FYI results of the fourth generation tests are also considered entirely conclusive at any time more than six weeks after an exposure.

I hope this information is helpful to you. EWH

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43 months ago

Thank you very much! Last thing, and not to be redundant but just to be sure……..based on my last questions (cuts on my hand), would you still not recommend PEP?

Edward W. Hook M.D.

43 months ago

As I presume you know, we provide three responses to each clients questions. This will be my third response.

Absolutely. No risk means no risk. Were you to present to be in my clinic with all of the detail you have provided I would not be willing to provide you with a prescription for PEP. In fact I would consider it malpractice to do so. You are not at risk for HIV from the event you describe.

I hope the information I have provided will help you. This completes this thread. EWH

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