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Author Topic: Unsure of risk/need for PEP after potential exposure  (Read 2338 times)

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Offline drezy347

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Unsure of risk/need for PEP after potential exposure
« on: July 23, 2013, 07:08:59 AM »
Hi, thank you for this amazing resource.

I need some advice.

Last week, I had 2 minutes of UAI as the receptive partner with a man whose serostatus I do not know, but who claims to be negative. It was a substance induced error in judgement. He was circumcised and did not ejaculate or precum, however I did douche before we had sex, and there was some rough fingerplay although I did not observe any rectal bleeding.

I began a course of PEP 21 hours after - Truvada + Isentress. I have no side effects except being very groggy and fatigued, which is hindering my ability to concentrate for finals.

I am considering discontinuing PEP... I believe, as my doctor did, that my risk was low for this incident... but I am fearful that if I discontinue PEP now and later seroconvert, that I would be resistant to these drugs.

My questions are.. do you agree that my risk was generally low? And, what could happen if I discontinue treatment now and seroconvert later, re: resistance?

Offline Ann

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Re: Unsure of risk/need for PEP after potential exposure
« Reply #1 on: July 23, 2013, 08:01:36 AM »

The grogginess and fatigue you are experiencing are very likely being caused by the Isentress.

Truvada on its own is an effective, approved PEP regimen, so you could drop the Isentress and continue with the Truvada and still be protected. (Truvada has two meds in it.)

You should be side-effect free on Truvada alone. It may take a day or two for the Isentress side-effects to subside, depending on how long you've been taking it.

Just make sure you take the Truvada every day, as close to 24 hours apart as humanly possible.

If I were you, I'd definitely continue with the Truvada. You have had a risk, but continuing the Truvada will mean that you will most certainly test hiv negative.

You need to know that the earliest you should test post-PEP is at six weeks.

A six week post-PEP negative is highly unlikely to change, but must be confirmed at the three month post-PEP point.

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Offline drezy347

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Re: Unsure of risk/need for PEP after potential exposure
« Reply #2 on: August 03, 2013, 06:51:11 AM »
Thank you Ann. I have 12 days left in PEP therapy. My doctor strongly advised not to discontinue Isentress due to his personal belief that its mechanism of action is superior to Truvada.

My monogamous partner wants to try unprotected sex, and suggested that we test together now, and again after four weeks before doing so.

If I were infected, I imagine I would continue to test negative at both these testing times and he would be at risk.

My question is, could I pass on HIV (if I really were infected) while I'm on PEP if we had unprotected sex now? When should I test after finishing PEP for a definitive result?

Offline Andy Velez

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Re: Unsure of risk/need for PEP after potential exposure
« Reply #3 on: August 03, 2013, 08:08:15 AM »
Drezy, during this interim waiting period I would urge you and your partner to NOT have unprotected intercourse.

Hopefully you are going to test negative but why do something that is potentially risky for him?

You can test initially at 6 weeks after completing PEP. Assuming you get a negative result, that would be highly unlikely to change when you re-test at 3 months after completing PEP. A negative at 3 months is conclusive.

Andy Velez

Offline drezy347

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Re: Unsure of risk/need for PEP after potential exposure
« Reply #4 on: August 30, 2013, 08:27:24 AM »
I've been off PEP for 2 weeks now, completing my full course of treatment. Last night, my known-negative insertive partner dipped when I was under the influence of alcohol. It lasted around 3/4 minutes before I demanded a condom.. I went for a full STI test including fingerprick and Duo today - fingerprick was negative.

I know that this is not the appropriate time to test.

I asked my physician if I should advise my partner to go on PEP and she advised against it, citing my initial low-risk exposure which caused me to get PEP to begin with, and the low risk of last night.

I love my partner and can't think even of 1% exposing him to risk.

What do you think his realistic risk is?

Offline Andy Velez

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Re: Unsure of risk/need for PEP after potential exposure
« Reply #5 on: August 30, 2013, 08:31:23 AM »
Drez, you had a relatively low level risk to begin with. Given what you have reported of your activities I am expecting you to ultimately test negative.

With that in mind and the single brevity of your partner's dipping with you, urging him to go on PEP is an excessive overreaction. I expect both of you to come out of this ok.
Andy Velez


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