[Question #8946] Missed PEP Dosage

38 months ago

Thank you doctor and I’m sorry for the confusion so I have to clarify.

I said he “claimed” because he was attempting to penetrate me the entire night after I kept saying no. He’s not exactly to be trusted or believed… I don’t think most men would admit to successfully committing assault.

So while I understand there’s a chance he’s being honest, I also know what he had attempted to do and the chance he actually did penetrate me even for a brief moment.

So again, if he DID penetrate me for a moment and I DID miss 2 doses of PEP would it greatly effect the efficiency of PEP? And what would be my chances of being infected?

H. Hunter Handsfield, MD

38 months ago

*Sigh* You continue to miss my important points. With unprotected vaginal sex to completion (say 10-15 minutes), with ejaculation, by an HIV infected male not on anti-HIV treatment, the risk of the female partner becoming infected is around one in a thousand (a published estimate from CDC). When you add that there was no ejaculation in your vagina, and it even isn't certain you were penetrated at all (probably not!), and the low chance your partner has HIV, I would judge the risk you were infected at well under one chance in many million.

"... if he DID penetrate me for a moment and I DID miss 2 doses of PEP would it greatly effect the efficiency of PEP?" No, it would not. "And what would be my chances of being infected?" Still under one chance in many million, i.e. zero for all practical purposes.

Do your best to not second guess the situation -- i.e. stop the "what if", "yes but", or "could I be the exception" sorts of questions. I will not reply to them. And do your best to understand and believe my expert assessment. As I noted above, in 15 years not one questioner has turned out to have caught HIV. There is no realistic chance you will be the first.

Got it?

HHH, MD

---
---

38 months ago

My apologies it’s just a very stressful time for me, I’m sure you experience that a lot however.

I only have 2 more questions.

A third dose was missed, but only of Isentress, is this 3rd missed dose significant to the efficiency of PEP?

And finally will a 14 day RNA test and 6 week 4th gen test be conclusive for this exposure? I saw you said some experts recommend a 3 month test but would you consider these two tests sufficient?

Thank you and that’ll be all

H. Hunter Handsfield, MD

37 months ago

Missing part of the third dose: I doubt that has any effect.

In absence of solid data, I cannot argue strongly against a final test 3 mo. after completing PEP. However, I believe it is unnecessary, that a 6 week AgAb test is sufficient. I would think the combination of negative PCR at 2 weeks and AgAb at 6 weeks is 100% conclusive.

Best wishes and stay safe.

---

37 months ago

Thank you again doctor. I also just remembered his roommate was an escort, if they had relations or intimate contact would that increase my risk? Including all previous factors I’ve mentioned such as 3 missed doses of PEP

Also would a 10 day RNA + 6 week 4th gen test be sufficient for this situation as well? If 14 days is better than 10 days for RNA then I can wait but I am getting more impatient as it gets closer.

Since this will be my last reply I guess I’d also like to ask for an overall risk assessment with all the factors I’ve mentioned taken into consideration including potential brief penile penetration into my vagina and 3 thrown up/missed PEP doses.

Thank you for your knowledge and patience throughout.

H. Hunter Handsfield, MD

37 months ago

From my initial response in this thread 3 days ago: "Do your best to not second guess the situation -- i.e. stop the 'what if', 'yes but', or 'could I be the exception' sorts of questions. I will not reply to them." And that is exactly what these additional questions are. And you already have my overall risk assessment, which has not change despite all the add-on information you provided. There is no realistic chance you have HIV. I suggest you go back and re-read every question you asked and every reply in both this and your preceding thread. The answers are there.

Please note the forum does not permit repeated questions on the same topic or exposure. This will have to be your last one; future new questions about this exposure,PEP, testing, and your fears about HIV may receive no reply and the posting fee will not be refunded. This policy is based on compassion, not criticism, and is intended to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thanks for your understanding.

I do hope the discussions have been helpful.

---
---