Sexual Assault and PEP

[exhibitq]

Hi Everyone,

I am posting here because I do not really have anyone I can turn to in my personal life at the moment and I really just need to ask these questions, even if the answers are not what I want, because I feel like I am drowning.  A few nights ago, I was sexually assaulted by a man and it involved unprotected anal penetration, him penetrating me.  He did not ejaculate but I did bleed.  I do not know his HIV status.

Within 8 hours, I managed to get myself to the ER and within 12 hours of the incident, I was prescribed and started taking PEP.

I don't know what I am looking for, I guess, I am really just very scared and do not know who to turn to.  I know I have to wait three months before I know if it was effective and if I am clean, but does anyone know statistics in regards to PEP?  Is it effective in this situation.  Amazingly, have not had really any major side effects.

If he was HIV+, and I know this is hard to calculate but I am searching for something to hold on to right now, what are the chances I am infected?  Is there anything I can do besides PEP to help prevent it at this point?

Thank you in advance.

[Ann]

I know I have to wait three months before I know if it was effective and if I am clean

Exhibit,

You'll know you're clean when you get out of the shower. I'm clean - but I'm also hiv positive. To use the term "clean" to describe someone's sexual health or hiv status implies that those of us living with hiv are dirty. Don't use that term in that way here again. Thank you.

PEP is very effective when started in a timely fashion, which you did. PEP should be initiated no less than 72 hours (three days) following a risk, but less than 36 hours is best. You started way before that. You are highly UNlikely to end up positive due to this assault, provided you keep taking the PEP for the recommended four weeks (28 days).

PEP changes the hiv testing window period by four weeks - the time you are on PEP. You have to count the window period starting from your last dose of PEP.

The earliest you should test (and I hope you were given a baseline rapid hiv test before you were given PEP) is six weeks after your last dose of PEP. A negative result at this point will more likely than not remain negative when you confirm at the three month post-PEP point.

There are no other things you can do at this point to prevent hiv infection, other than continuing on with the PEP. As I stated above, PEP is VERY effective and I do not expect you will test positive.

You should also test for all the other, MUCH more easily transmitted STIs. Most of these can be tested for ten days to two weeks following the incident. One exception is syphilis, which shares a three month testing window period with hiv. (PEP has no bearing on any STI tests other than hiv.)

Sorry to hear about this traumatic event, but as you started PEP in a very timely manner, I fully expect you will come out of this hiv negative.

Please consider counseling to help you come to terms with the emotional aspects of this trying time in your life. You're going to come out of this ok in relation to hiv - and counseling will help you come out of this ok in relation to your emotional well-being.

Ann

PS - please keep in mind that you only have two free posts left, so use them wisely.

[exhibitq]

Ann,

Thank you for taking the time to reply to my post, I really appreciate your words.  Also, I sincerely apologize for how I phrased that.  I will not use that term again, my apologies, it was senseless of me.  Thank you for pointing it out to me.

What you said echoes what I heard from the Infectious Diseases Doctor who I saw today (per ER instructions) and it has taken quite a burden off of my mind.  He will be helping me with timing my HIV tests from here on out to determine my status.  And for that matter, I was given an HIV test before starting PEP and the result was negative.  I get tested regularly and have been in a monogamous relationship for three years so I was not surprised by that result.

Also at my ER visit, I received treatment for other STIs and was tested for Syphilis, which came back nonreactive.  I did not receive treatment for Syphilis as the IF Doctor said we would monitor it and treat as necessary.  I suppose they prefer to administer penicillin more sparingly so one does not become immune to it?  I am not sure.

I am in the process of getting the rest of my 28-day supply of PEP medications and will be doing a viral load analysis, as per my Doctor's recommendation, in four weeks (from today, not from the end of my PEP treatment).  I will be sure to mark it three months from when I finish PEP treatment.

Thank you so much for taking the time to reply to me matter-of-factly, this has been a hard time for many reasons and it was so wonderful to have a place where I could post my concerns and questions.  I really appreciate what this community is doing and thanks again for posting back to me Ann. And I am getting counseling from the survivor advocacy group here where I live.  One step at a time.

Yours,

Exhibit

[Ann]

Exhibit,

They likely didn't go ahead and treat for syphilis because it's not a very pleasant treatment. It entails two or three shots (one per week) in the butt-cheeks and many people describe them as "cement shots".

They hurt like hell going in and leave you feeling like you've been kicked in the ass by an ass a donkey for a day or two afterwards. There's no point in putting a person through that if they haven't tested positive for syphilis.

Make sure you get tested again for syphilis three months after the assault for a conclusive negative. Syphilis chancres are painless and unless you get one where you can see it, you won't know it's there. Testing is the only way to know for sure if you've been infected or not.

While the treatment isn't nice, it's wholly preferable to untreated syphilis.

will be doing a viral load analysis, as per my Doctor's recommendation, in four weeks (from today, not from the end of my PEP treatment).

There's not much point to doing a VL test at that point. PEP suppresses the virus and it's a no-brainer that the VL result will be negative that soon after PEP. It's a useless test in this particular context of doing it four weeks after you've started PEP.

It's an expensive test, so if you're paying for this out-of-pocket at all (including co-pay), there's no reason why you can't refuse to have this test done. There's little to no point in having it done at that time.

All you will really need is standard antibody testing at the appropriate time (six weeks and three months post-PEP). And I do expect that you will test negative.

I'm happy to hear you're getting counseling. Stick with it (and the PEP) and you'll be ok.

Ann

[exhibitq]

Ann,

Thanks or clarifying all of that for me about the syphilis shots and the VL test. Fortunately, in my state in the US, they provide free medical care for anything that is directly related to the assault for 90 days. This has been a blessing that has me follow orders without having to worry about money.

I realize this is my last free post but I need to use it now (if I have to subscribe later I will be happy to do so and support this community). I have a drug related question. I know that this is a medical question but because it is Sunday I cannot get a hold of a medical professional and this is time sensitive.

The IF doctor switched me from taking kaletra and combivir twice a day to taking atripla once a day. This would be fine but when I went to the pharmacy to pick up the prescription they were having issues processing my medical care voucher and said I had to wait until Monday. I explained that this was timesensitive and quite urgent. After much stress they agreed to give me to tablets of altripla which would hold me for two days. I got them this morning.

This is where my question comes in. The Doctor said to take them in the evening before going to bed and not to worry about a mornin dose of kaletra and combivir. This morning, I did not know if I would get te medication I needed so I took my last dose of kaletra and combivir. Is it safe to take my atripla tonight before bed as prescribed or do I have to wait? I didn't want to miss a dose, I am trying to be very deligent.

If anyone has first had experience with this, or perhaps a US hotline I could call to ask, I would e very grateful.

Thanks again, everyone!

Exhibit

[jkinatl2]

I understand your dilemma.  It happens a lot to those of us who have to switch drugs. And the only negative to taking your Atripla tonight after having had the other medications this morning is the possibility of enhanced side effects.

And this is only a possibility, not a certainty. Were I in your shoes, I would probably go ahead and take the Atripla tonight. You might experience sleep issues and other side effects that may be enhanced by having more of the drugs in your system, but as a one-time thing it won't do you any harm.

The convenience of Atripla, combined with the cessation of Kaletra (I did not read whether you have had the intestinal distress that often accompanies Kaletra) will make your regimen much easier, though if the CNS issues sometimes associated with a component of Atripla become too distracting,  you should inform your doctor. This is, however, not necessarily likely to happen - especially since you will be on the drug for less than a month.

I am very glad that your pharmacy understands the time sensitive nature of the drugs you are taking, and am relieved to know that you are receiving good healthcare during this difficult time.


*modified because I am typing on a screen roughly the size of a small rodent.

[Ann]

Exhibit,

Wow, I applaud your state for taking care of sexual assault victims financially so they can get the care they need. What a breath of fresh air! May I ask what state?

If you weren't having gastrointestinal upset due to Kaletra, I'm surprised the doctor didn't keep the Kaletra and just switch you from Combivir (which has to be taken twice a day) to Truvada (once a day, like Kaletra) - because I'm assuming in the absence of side-effects, he probably switched you for the ease of once a day dosing. You're less likely to miss a (Combivir) dose that way.

Truvada is also approved to be taken once a day on its own for PEP - and it is effective at that dosage. The components of Truvada are also in Atripla. Atripla also contains Sustiva and that's where you may get the sleep issues Jonathan mentioned.

Atripla normally isn't used for PEP because of the Sustiva side effects (not because it's not effective, it is). You should take the Atripla before bed and at least two hours after eating. If you need to eat closer to dosing time, make sure it's something low-fat. Food and particularly high-fat food can make the Sustiva side effects much stronger.

You may also develop a rash - another possible side effect of Sustiva. If you start getting a rash, get in touch with your doctor asap.

You can read more about the meds you're taking (and were taking) here.

And yes, take your Atripla tonight, before bed, on as empty a stomach as possible.

*modified because I am typing on a screen roughly the size of a small rodent.

Jonathan, put the duct-tape and the hamster down and back away slowly....