HIV in rectal secretions

[concernedfriend]

I am a Physician Assistant student trying to help a friend get through a tough time while using my limited knowledge of HIV/AIDS.  I was wondering if some of you could help give me an idea of the risk for my friend and for my own knowledge to use later on down the road professionally. 

Scenario:
Healthy (HIV negative and STI negative) male has unprotected insertive anal dipping (2-3 strokes, approx 1 min with slow insertion) on a male partner with unknown status.  There was also some lubrication (spit and commercial lubrication).  Incident occured at about 3AM on 7/5/07.  Having talk about it prior the two men get tested for HIV (rapid test) on 7/6 and the receptive partner comes back reactive for HIV.  The insertive male goes out and gets started on PEP.  Is only prescribed the two drugs in combivir and no PI. 

The receptive (assumed HIV-positive male) goes and gets re-tested for HIV and tested for STIs.  Just yesterday the receptive male came back as Hep A positive, Syphilis positive (RPR 1:16), and with a CD4 of 88.  Now we can assume the receptive male has AIDS due to the CD4 count, can we assume he has a high viral load, and if so how does that affect the other persons risk?  The receptive male denies any recent or ever having sores or ulcerations, flu-like symptoms, or rash.  With the short duration, use of lubrication, no sores on the insertive partner what are the risks for the insertive partner? 

Since then my friend (the insertive partner) has gotten re-tested for HIV and all STIs at 10 days and should get the results any day now.  He plans to get treated for Syphilis no matter what as a precaution and continues to take the PEP.  He is having a very hard time dealing with the and any advise or help would be greatly appreciated.
If you could give numbers or statistics, my friend (the insertive partner) loves to use statistics. 

Thank you

[RapidRod]

One, being in the medicial field myself, I can't imagine that a PA would be asking these questions. Are you telling me you can't advise your friend about the risks of having unprotected sex, HIV and STD questions? I'm sorry I'm not falling for this one.

[concernedfriend]

RapidRod - Believe all you want. I have done much research on the internet and through the resources I have at hand, and I have advised my friend of what I believe is the risk.  My purpose for coming on here and posting this is simply to get an idea from others that might be more educated then myself on the specific risks.  I am not in Infectious Disease so don't have as much information as others.  I think it is in the best interest of every patient that I see that I get the most knowledge that I can from whatever source that I can, especially if I am not knowledge about a subject.

I have told him my thoughts, I am just asking for other opinions to bring to the table. 

[Andy Velez]

We prefer not to deal in statistics here, but rather with real situations which require a response.

If the HIV+ partner is on meds there is the likelihood but not a certainty that his vl is down.

As far as your friend is concerned, taking PEP is no walk in the park. Hopefully it will serve to remind him that he can dip and screw as much as he wants to with anyone he wants to as long as he always, ALWAYS uses a condom. No exceptions. Everytime he screws without a condom he is putting his life at risk. It's as stark and as simple as that.

Hopefully he will come out of this ok, but low risk is not the same as no risk, as a lot of HIV+ people can tell  you.

Cheers,

[concernedfriend]

Not sure if this is the right place to ask this, but I was wondering what people knew about the thought that the amount of HIV is higher in "rectal secretions" then any other body fluid.  I have only been able to find 1-2 articles that actually studied this.  If this is true then why isn't it more widely publicized that HIV is more prevalent in rectal secretions then blood, semen, or vaginal fluids?

[Ann]

concerned,

I've merged your new thread into your original thread - where you should post all your additional thoughts or questions. It helps us to help you when you keep all your additional thoughts or questions in one thread.

If you need help finding your thread when you come here, click on the "Show own posts" link under your name in the left-hand column of any forum page.

Please also read through the Welcome Thread so you can familiarize yourself with our Forum Posting Guidelines. Thank you for your cooperation.

The message we need to get out is that any unprotected anal or vaginal intercourse is risky where hiv is concerned. I don't see the point in nit-picking between which bodily fluid may or may not contain more hiv.

Ann