Unprotected sex with a HIV positive woman with a high viral load of 700,000

[anurag]

Hello friends,

Unfortunately and stupidly, I had unprotected vaginal sex with a woman. At 22 hours post exposure, I started the emergency PEP treatment and am currently on day 4 of PEP. I also urged the concerned woman to under HIV ELISA (4th Gen) and HIV RNA and her results are as follows: ELISA - REACTIVE; HIV RNA - 700,000 IU/ml. My questions are as follows:

1. In terms of statistics, how likely are the chances of HIV transmission from a HIV positive woman with a high viral load of 700,000? Can I 100% assume that with such a  high viral load, I must have most definitely contracted HIV infection from her, given that we indulged in unprotected vaginal sex?

2. How effective is emergency PEP treatment in case the virus transferred had a high viral load of 700,000? In other words, does the efficacy of PEP vary depending upon the viral load of the HIV positive person transmitting the virus?

I shall be extremely thankful if I may have some expert insight. 

Best regards,

Anurag

[Jim Allen]

1.
No. Look statistics do not really apply to individual cases, nobody can calculate your odds, however even with a high VL transmission is rare on a single heterosexual act to the insertive  partner.

2.
No, the VL made no difference. In a short and crude explanation, you are taking PEP as you are presuming HIV has been transmitted to you, the pep medication simply stops the virus from taking hold on your cells or building a reservoir thus leaving it die off.

Finish the PEP course and test 6 & 13 weeks post finishing PEP. You started PEP soon after the possible exposure and so all in all I suspect when you do test the result will be negative.

Here's what you need to know in order to avoid hiv infection:
Use condoms for anal or vaginal intercourse, correctly and consistently, every time, no exceptions.


Keep in mind that some sexual practices which may be described as ‘safe’ in terms of HIV transmission might still pose a risk for transmission of other STI's, so please do get fully tested regularly and at least yearly for all STI's including but not limited to HIV and test more frequently if unprotected intercourse occurs

Also note that it is possible to have an STI and show no signs or symptoms and the only way of knowing is by testing.

More information on HIV Basics, PEP, TaSP and Transmission can be found through the links in my signature to our POZ pages, this includes information on HIV Testing

Kind regards

Jim

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[anurag]

1.
No. Look statistics do not really apply to individual cases, nobody can calculate your odds, however even with a high VL transmission is rare on a single heterosexual act to the insertive  partner.

Thank you so much for your quick response Jim!!

Just so I may educate myself a little more, may I ask you to throw some light on why even with a high viral load transmission chances are rare on a single heterosexual act - I mean to say why should the number of acts make a difference, be it 1 or 10, as long as the person had a very high viral load rendering the possibility of transmission quite high?

I hope I do not sound offensive, as that is not my intent. I am hoping your answer may help not just me but millions of others who read this forum.

Best,

Anurag

[Jim Allen]

Your basically in a round about way asking about odds. Nobody on god green earth can calculate your personal risk. Numbers and probabilities are often misinterpreted or misunderstood.

Why its less common or more difficult to transmit to the insertive partner, well it is simple really the surface area for HIV to enter or exposed area is a lot smaller, also the fluids a man potentially exposes a women to during unprotected intercourse has a higher concentration of HIV than other-way around.  Statistically speaking your odds are about 1 in 2,500 of infection, people misunderstand this as "low risk" its all it means is that out of 2500 exposures, on average, one will lead to HIV; bad luck might have it that the transmission occurs on the very first and only exposure!, and this does happen in the real world, there are plenty of heterosexual men here who only had 1 exposure.

This is all however irrelevant and also pointless to worry about or wonder about, here is the situation plain and simple, you had a risk so take your PEP and test as per guidelines, that is all you need to focus on and remember to use condoms next time.

Jim

[anurag]

Thank you Jim!

Fingers crossed, I'll be able to bear the side effects of PEP and complete the course.

Thank you again.

Best regards,

Anurag

[Jim Allen]

You're welcome.

Side effects well other than a few days/week of very mild adjustment at most, you should simply expect none.

Jim