On demand-prep and VERY HIGH risk exposure

[huangDi]

Greetings to everyone, I want to express my thankfulness for the perseverance of the mods of this wonderful online community. I am quite distressed as i had a sexual exposure of very high risk just 2 days ago.

I recently learned about on-demand prep and given my infrequent hookups and my need to have an extra layer of protection, I decided this is a solution that could work for me without having to worry about daily adherence. So i decided to engage in receptive anal sex with a partner on Friday night and 4 hours earlier I took the 2 pills of PreP (Tenofovir Disoproxil Fumarate & Emtricitabine 300/200 mg). 4 hours after the two pills were taken, I met with the person and we had anal sex. I saw him opening the condoms box while i laid my back on him and made love. A few minutes later we stopped and I realized in great HORROR that HE WAS NOT WEARING A CONDOM. I got really upset about it and he apologized by saying he gets tested regularly and does not usually do that. He even showed me the results of a 4th generation HIV negative test he took about 20 days ago...This, combined with me being on On-demand PreP helped me alleviate most of the anxiety I am going through.

Now the problem is, if he was infected recently enough for the 4th generation NOT being able to pick the infection up, his viral load during this may be sky-rocket high and I am really afraid as I engaged in the riskiest sexual behaviour (unprotected receptive anal sex) + the fact that I took the 2 pills only 4 hours before the exposure and not the "ideal" 24 hours for on demand prep. The double dosage also gave me some sort of stomachache the next morning and I threw up. I adhered faithfully to the on-demand pill scheduling and I popped another pill 24 hours after the first double dosage, and I'm planning to pop the last one today.

Do you think Prep will protect me despite all the misfortunes of this encounter ?
Do you think throwing up the next morning could limit the effect of PreP consumed the previous evening ?

[Jim Allen]

Hiya,

I read your post three times, what this person did might be a criminal offence in some jurisdictions and I am sorry to hear this happened to you.

In brief, there was condomless intercourse but you are taking PrEP On-demand and started 4 hours before sex. On-demand (event-based PrEP) is highly effective and the initial double dose should be between 24 and 2 hours before sex. https://i-base.info/guides/prep/real-life-examples-for-on-demand-dosing

Their test results are meaningless to you due to the window period and for several other reasons and puking the next day will not change PrEPs effectiveness.

Anyhow, I read what you posted here and I see no reason for any HIV stress or testing outside of routine, as you are using PrEP ideally you should get an HIV & STI screening every three months.


Here's what you need to know to reduce your HIV risks:
Use condoms for anal or vaginal intercourse correctly and consistently, with no exceptions. Continue to use PrEP as an additional layer of protection against HIV and get vaccinated against HPV, Hepatitis A & B.

Keep in mind that some sexual practices described as safe in terms of acquiring HIV still pose a risk for other easier-acquired STIs. So please get tested routinely, ideally every three months as a PrEP user.

Also, note that it is possible to have an STI and show no signs or symptoms; testing is the only way to know.

Kind regards

Jim

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