I started PrEP about 7 months ago (daily) and decided to stop PrEP out of concern since there were traces of albumin in my recent urinalysis. 

Last 13 January 2023 I had unprotected sex, however stopped PrEP last 18 January 2023 (I took daily PrEP for 5 days after exposure before stopping). 

Should I continue to take PrEP after initially stopping for 3 days?

Am I at any significant risk for HIV? (I was insertive/“top”)

Also, are traces of albumin a sign for PrEP-related kidney damage?

Thank you very much, doctors!

Kidney damage is not a common side effect of the usual antiretroviral (anti-HIV) drugs, including those used for PrEP, and entirely healthy people occasionally have trace amounts of albumin in their urine. I would not have stopped PrEP in this circumstance, and instead would have recommended repeat urinalysis (a few times) to see if albumin persists increases to more than trace levels; and if so, blood tests of kidney function. You probably can safely resume PrEP:  the health risk of HIV are hundreds of times greater than the likelihood of significant kidney disease. If any doubt persists, discuss with the clinic or doctor who prescribed your PrEP.

PrEP effectiveness depends on drug being on board at the time of exposure, and perhaps the next 2-3 days. Stopping 5 days after exposure would not reduce effectiveness for that event.

Without PrEP, the average risk of HIV from unprotected insertive anal sex, if the receptive (bottom) partner has untreated HIV, is estimated by CDC to be about once per 1,000 exposures.

Here comes a lecture that you might not have anticipated. I am quite concerned about your sexual safety. Unprotected anal sex??? Despite PrEP, I would strongly urge you to use condoms for anal sex (either as top or bottom); you're at very high risk of syphilis, which is very dangerous in itself (e.g. stroke, blindness), as well as gonorrhea, chlamydia, herpes, and all the other STIs you would prefer to avoid. In addition, it seems you're not discussing HIV status with your partners, right? No MSM should be having sex without first discussing HIV status and avoiding unprotected anal with those who are infected but not known to be on effective treatment. You're playing with HIV fire, if you do not resume PrEP. Please take heed!

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

I really needed that lecture. It’s quite the wake up call especially knowing that HIV isn’t the only thing out there. This is definitely an experience I will never forget. While I do discuss status and ask if they’re also on PrEP/treatment, I am erring on the side of caution and assume they may not entirely being truthful (which in hindsight still meant that I should have used a condom either way).

The PrEP I’m taking is “Emtricitabine/Tenofovir Disoproxil Fumarate”. Would just like to clarify some points to finally put my worries to rest:

2. Does the circumstance warrant an HIV test?

** https://www.sfaf.org/collections/beta/prep-facts-starting-stopping-prep-care/

Should you be tested? In general, I do not advise testing after any particular exposures unless overtly high risk, like unprotected anal with a known infected (and untreated) partner.  A smarter strategy is periodic testing, e.g. every 3-12 months depending on sexual frequency. That said, this advice doesn't account for the reassurance value of a negative test result; some people are naturally more reassured by a negative test than by professional opinion based on probability and statistics. Personally, if somehow I were in your situation, I would not be tested. But I'm not you and you'll need to make your own decision. If you do it, have an AgAb (4th generation) blood test 4-6 weeks after your last PrEP dose.

So to sum everything up, I can rest assured that I was protected from HIV from that encounter since I took PrEP daily for 7 months + 5 days after the date of the exposure?

Though I plan to get tested after 4-6 weeks, if I understood your comments correctly, the statistics look good and would allay some of my anxieties. 

Apologies if I need to clarify multiple times, English isn’t my first language and sometimes I can find it quite difficult to understand what I’m reading implies. 

Thank you very much doctor for your help, as always! Thread can be closed after. 

The 7 months of PrEP prior to the exposure is irrelevant, but 5 days afterward probably was largely if not perfectly protective. I hope you resume PrEP; I see no reason not to do so. However, if your sexual experiences with other men occur less often than once a month, you might consider post-exposure prophylaxis (PEP) instead of PrEP. For example, such events occur 4 times a year, there would be four 1-month treatments with ARVs instead of continuous. Perhaps something to discuss with your doctor or clinic.

Thanks for the thanks. I'm glad to have helped. Best wishes and stay safe.