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Author Topic: Unsure of risk/need for PEP after potential exposure  (Read 4170 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 »
drezy,

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.

Ann
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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

Offline drezy347

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Re: Unsure of risk/need for PEP after potential exposure
« Reply #6 on: May 11, 2016, 09:10:45 PM »
I've just been prescribed a 30-day PEP regimen of Truvada + ritonavir + atazanavir 12 hours after receptive UAI w/ ejaculation, with a partner who was diagnosed HIV+ when we went to be tested. I argued with the doctor to switch to an Issentris + Truvada regime, but he said that the combo I received is their standard recommendation, and that I would have to pay for the Issentris if I wanted it.

Is there more of a better profile for PEP w/ the T+I vs the drugs that I am on?

Online JimDublin

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Re: Unsure of risk/need for PEP after potential exposure
« Reply #7 on: May 12, 2016, 02:29:32 AM »
The combination of medication you have is also effective, there are a number of combinations that can be used for PEP.

My advice is take the medication as prescribed and test at 6 & 13 weeks post PEP.

Jim
HIV 101 - Index & everything you need to know
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HIV Transmission and Risks
You can read more about Testing here:
HIV Testing
You can read more about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read more about HIV prevention here:
HIV prevention
You can read more about PEP and PrEP here
PEP and PrEP

Offline drezy347

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Re: Unsure of risk/need for PEP after potential exposure
« Reply #8 on: May 12, 2016, 02:55:43 AM »
Thank you Jim. Assuming that I could pay for the Issentris, would you still advise to stay on the current treatment? I guess what I'm asking is if it will hurt the therapeutic outcome to switch out the protease inhibitors for an integrase inhibitor on day 2 of PEP.

Online JimDublin

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Re: Unsure of risk/need for PEP after potential exposure
« Reply #9 on: May 12, 2016, 03:02:14 AM »
My advice is not to change meds as you have now started this combination consider yourself committed to it and finish the course.

Jim
HIV 101 - Index & everything you need to know
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You can read more about Transmission and Risks here:
HIV Transmission and Risks
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HIV Testing
You can read more about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read more about HIV prevention here:
HIV prevention
You can read more about PEP and PrEP here
PEP and PrEP

Offline drezy347

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Re: Unsure of risk/need for PEP after potential exposure
« Reply #10 on: May 13, 2016, 06:08:44 AM »
Hi again. Sorry to be annoying. I have two issues on day 3.. the gastric side effects are horrible on the protease inhibitors. I normally suffer from acid reflux and have to take PPIs like Nexium, but I have been off of them for a while and I can't take them while on the protease inhibitors.

The other thing is, we can't contact trace the person who infected my partner to know whether they've ever been on treatment, but we do know that they were aware of their status. I'm a little worried about resistance to the protease inhibitors I'm on now, but my doctor isn't.

I know that I should stick to this course, but my mind keeps coming up with scenarios... at 50 hrs post exposure, and day 3 of the current regimen, is it worth discussing with my doctor again the possibility of swapping for less side effects? Is this ever done in PEP with an ok outcome?
« Last Edit: May 13, 2016, 06:27:21 AM by drezy347 »

Online JimDublin

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Re: Unsure of risk/need for PEP after potential exposure
« Reply #11 on: May 13, 2016, 08:55:34 AM »
Quote
The other thing is, we can't contact trace the person who infected my partner to know whether they've ever been on treatment, but we do know that they were aware of their status. I'm a little worried about resistance to the protease inhibitors I'm on now, but my doctor isn't.

Utterly pointless to think about or concern yourself with. Even if you knew who it does not mean your going to get access to medical records regarding resistance even if they have been tested. Stop focusing on that part of the story, its a closed book already.

Quote
I know that I should stick to this course, but my mind keeps coming up with scenarios... at 50 hrs post exposure, and day 3 of the current regimen, is it worth discussing with my doctor again the possibility of swapping for less side effects? Is this ever done in PEP with an ok outcome?

If you that worried talk to your Doctor again but I don't see them swapping your meds.  Side affects normally settle quickly after a few days/weeks but if you sick and unsure talk to you Doctor.

Jim
HIV 101 - Index & everything you need to know
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HIV prevention
You can read more about PEP and PrEP here
PEP and PrEP

Offline drezy347

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Re: Unsure of risk/need for PEP after potential exposure
« Reply #12 on: June 28, 2016, 01:19:47 AM »
Hey so it's around 6 weeks post exposure... I've managed to have an anxiety attack every day of the six weeks. I had a relatively ok period on PEP, but I am terrified of going into test. Around wk 2/3 I noticed my submandibular lymph nodes/salivary glands get bigger, but they seem to come and go, increase or decrease in size. I also have a small lump on the side of my neck by my shoulder that seemed prominent for a day or two then got smaller. Nothing else... no other lymph areas.. (Granted, I did have a few cuts and scrapes under my chin from shaving before my exposure... and the nodes only went down when I started to treat the scrapes)

You have helped me a lot. I'm just terrified of going in...

Online JimDublin

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Re: Unsure of risk/need for PEP after potential exposure
« Reply #13 on: June 28, 2016, 01:27:34 AM »
Go test, no matter what the outcome you will be fine.

Jim
HIV 101 - Index & everything you need to know
HIV 101
You can read more about Transmission and Risks here:
HIV Transmission and Risks
You can read more about Testing here:
HIV Testing
You can read more about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read more about HIV prevention here:
HIV prevention
You can read more about PEP and PrEP here
PEP and PrEP

Offline drezy347

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Re: Unsure of risk/need for PEP after potential exposure
« Reply #14 on: June 28, 2016, 01:29:58 AM »
Go test, no matter what the outcome you will be fine.

Jim
Yikes....did anything I say sound like it will be a bad outcome?

Online JimDublin

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Re: Unsure of risk/need for PEP after potential exposure
« Reply #15 on: June 28, 2016, 01:34:32 AM »
No but the test will have 1 of 2 outcomes and either way you will be fine.
Go test and stop stressing.

Jim
HIV 101 - Index & everything you need to know
HIV 101
You can read more about Transmission and Risks here:
HIV Transmission and Risks
You can read more about Testing here:
HIV Testing
You can read more about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read more about HIV prevention here:
HIV prevention
You can read more about PEP and PrEP here
PEP and PrEP

Offline drezy347

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Re: Unsure of risk/need for PEP after potential exposure
« Reply #16 on: September 02, 2016, 11:23:54 PM »
Just updating my post because when I was on this forum, I hated to see no conclusion to the stories. I tested today, finally, and it was negative.

Online JimDublin

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Re: Unsure of risk/need for PEP after potential exposure
« Reply #17 on: September 03, 2016, 02:29:22 AM »
Glad to hear the result was HIV negative.
Take care

Jim.
HIV 101 - Index & everything you need to know
HIV 101
You can read more about Transmission and Risks here:
HIV Transmission and Risks
You can read more about Testing here:
HIV Testing
You can read more about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read more about HIV prevention here:
HIV prevention
You can read more about PEP and PrEP here
PEP and PrEP

 


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