I need a risk assessment

[kelvin21]

I was involved with my first semi gay experience.  Can you read my story and give me an assessment?

Assume the guy was HIV positive:

The guy I met rubbed himself to erection then placed a condom on.  He rubbed my unprotected member with his hand for 4-5 strokes.  He then began to rub my anus with his fingers for about probably no more than 30 seconds.  At this time, he tried to penetrate me but I stopped him and left.  I felt pressure against the anus but I don't think there was penetration.  I am sure I would have known.  As far as I am aware, the condom was still on.  I began a tx. of pep 46 hours later and following up with an ID soon.  This was the first and last time for me.

1.  Does any behaviors listed here put me at risk for HIV?
2.  My main concern would be precum from placement of the condom (outside of condom) or precum on hands from rubbing himself prior to placing the condom on then contacting briefly my anus, penus  (urethra)?
3.  The meeting only lasted like 5 minutes, there was no other activity than whats listed here.  Do you think that PEP was warranted? If so, how effective is PEP treatment 46 hours post (combivir, viread 300)?
I understand that testing should be done 3 months post tx., but I am just curious about my risks.  I have been taking the meds for a couple of days now and have been experiencing constant diarrhea.

Thank you for taking the time to read my post.

[RapidRod]

1. No.
2. HIV is not transmitted outside its host.
3. No nPEP is not warranted you never had an exposure

You don't need testing.

[kelvin21]

Thanks for the response.
Shortly after the encounter (the next day), I experienced diarrhea for 2 days before starting pep. 
1.  Once on pep, I have had diarrhea non stop.  I know you said no risk involved, but if there was an infection could it cause diarrhea in less than a day or so after the incident?
2.  I have read various reports on the accuracy of nPEP.  Some recommend taking it no later than 36 hours, some recommend no later than 72 hours.  What is your take on percent effectiveness and window period associated with pep?
3.  Since you guys have much experience dealing with these problems over many years, have you ever recieved reports of infections from the activities listed? 

                 Thanks again.....

[RapidRod]

Thanks for the response.
Shortly after the encounter (the next day), I experienced diarrhea for 2 days before starting pep. 
1.  Once on pep, I have had diarrhea non stop.  I know you said no risk involved, but if there was an infection could it cause diarrhea in less than a day or so after the incident?
2.  I have read various reports on the accuracy of nPEP.  Some recommend taking it no later than 36 hours, some recommend no later than 72 hours.  What is your take on percent effectiveness and window period associated with pep?
3.  Since you guys have much experience dealing with these problems over many years, have you ever recieved reports of infections from the activities listed? 

                 Thanks again.....

You never should have been put on nPEP. 

[Andy Velez]

You are worrying needlessly about HIV. You weren't at risk since the guy wore a condom for the brief sort of insertion that took place.

I can only think that whoever prescribed PEP for you was either unclear about the exact details or else was persuaded by your anxiety to give it to you. It was totally unwarranted.

If your problem with diarrhea persists you should discuss it with your doctor. And if you are still taking PEP, well I think it's totally unnecessary but taking it or not is your decision and your doctor's.

In the case of a genuine risk such as unprotected vaginal or anal intercourse, PEP should be instituted as soon after the incident as possible. That means within 48-72 hours and the course is for 28 days. But this doesn't apply to your situation since I don't see there was an actual risk.   

[kelvin21]

Andy,

   You are right.  My anxiety levels sored through the roof and I convinced the doc to prescribe it for me.  I met the online and status unknown but highly probable that he is positive.

   My mind is going crazy, I have even pondered the question of whether he took the condom off or not prior to trying to penetrate.  These are most likely irrational thoughts on my part.  Even though I saw it on him before and after the brief attempted anal insertion.

    Thank you for alleviating some of my anxiety. 

     Do you know what the general percentage is of thrwarting a possible infection from pep.  I will be seeing the ID a week after start of treatment.  Since I started it and only have three weeks to go at that time, I am wondering if I should just continue the regimen.  Can you please advise?

[Andy Velez]

I don't think that PEP was ever needed in your situation. Since it was prescribed by a doctor I suggest you terminate it with the doctor's agreement. 

When there is a genuine risk and PEP is instituted early enough it has a high rate of effectiveness. And don't ask me to get into quantifying numbers because we don't do that here.

Without taking PEP I would still expect you to test negative at 13 weeks.

[kelvin21]

Andy,

    Thanks for the reassurances.  You guys do great work here.

[Andy Velez]

You are welcome. I'm glad you found the exchanges to be helpful.

[kelvin21]

Hello,

    I followed up with my ID, and the doc kept me on viread and switched me to kaletra for the remaining 21 days (14 days to go).  I have been on the regimen for two weeks.  Since starting Kaletra, I have had non stop diarrhea.  Today, I noticed a substantial amount of blood in my stool.  Does anyone here know if this could be a potential side effect of kaletra?  I am going to talk to my ID soon, but figured I would ask in this forum also.  Thanks for your help.

[RapidRod]

Hello,

    I followed up with my ID, and the doc kept me on viread and switched me to kaletra for the remaining 21 days (14 days to go).  I have been on the regimen for two weeks.  Since starting Kaletra, I have had non stop diarrhea.  Today, I noticed a substantial amount of blood in my stool.  Does anyone here know if this could be a potential side effect of kaletra?  I am going to talk to my ID soon, but figured I would ask in this forum also.  Thanks for your help.

Don't even want to hear about your non risk issues.

[Andy Velez]

You need to be discussing your symptoms with your doctor. We can't diagnose anything in this setting. I can tell you that if you have been having diarrhea, your anus is probably very sore and so bleeding would not be surprisng. Diarrhea is a common symptom related to the meds you are taking.

[kelvin21]

Thanks for the reply Andy.  I discovered that taking the kaletra with a good amount of food stops the diarrhea.  Now that I solved the diarrhea issues the meds are tolerable.  I will post my follow up testing results on here in a couple of months.  Thanks again for your help.

[Andy Velez]

You're welcome. Glad to hear you found a solution to the Kaletra problem. Good luck with the test which I expect will yield a negative result.