Condom

[kltown]

Dr. Jose,

As you know from my posts to you before, I have considerable anxiety about HIV and sex. I have also decided from this point onward I will not mix alcohol with sex. Just not worth it.

On Saturday evening I went out and had sex with a man I met a bar. We were drunk and I bottomed. It hurt really bad and so didnt last long, and he ejaculated outside of me. We had sex the next morning and he came outside again. We used a condom in the morning but I couldn't remember if we had used one at night. I asked him and he said yes, that he does not mess around with that kind of stuff, and he was actually tested two weeks ago negative. I felt better about it but now am a bit paranoid. All I have is his word. I generally don't have anal sax outside of a relationship...

Would you suggest PEP if all I have is his word? I have a supply of viread and epivir At home. Would those two drugs suffice? I presented falsely at a clinic for it a few weeks ago and all my labs came back normal. I am also going to schedule an appointment with my therapist. I just am worried he lied and I may get infected. There is no real indication of him lying- he seemed quite with it- but he was a stranger. If I did take PEP, would I need to take AZT, too,
To make it effective? I read epivir and viread were enough. I took the first dose of those pills 42 hours after exposure but not sure if I should continue.

What would you advise? are those two drugs enough? Is the risk of having unprotected anal sex as a bottom with no ejaculation inside a high risk? I'm iust a bit worried, though everyone is saying why would he lie when he had a risk too. I live in NYC and there is a high rate of HIV here, obviously.

Thanks in advance.

[kltown]

Sorry, one more question related to meds:

1) Don't Epivir and Viread essentially "make up" Truvada? I started those pills at 42 hours, but the AZT at 72 hours. Is it worthless to keep going or should I continue with both?  

2) Why is the triple regimen suggested when Truvada (Epivir and Viread or close to it) worked in prevention in iPrex cases? I've read AZT is not so well tolerated, hence the reliance on Truvada.

3) Do you believe Epivir and Viread would be of adequate use for this situation if I did decide to drop the AZT?

Is this purely a "more drugs in the arsenal" situation?

[kltown]

Sean,

Thanks for your reply.

My partner said we used a condom. I am not 100% sure because I was intoxicated. In that manner, you would still suggest PEP?

I am wondering if it is worth it at this point. It is 72 hours post-exposure for me right now and I took the triple therapy that I have-- Epivir, Viread, and AZT. I took a dose of Epivir and Viread at 42 hours and then decided I was being paranoid he didn't use a condom [since I only have his word] but read your post and got nervous, so I took a dose of Epivir and Viread late by 6 hours. I started the AZT for the first time at about 72 hours. Should I continue the AZT at the 72 hour mark and the Epivir and Viread at the original mark or at the later mark? Will this have an affect?

I have hypochondria and anxiety disorder and presented for PEP recently a few weeks ago for a case in which Dr. Jose said I didn't need it, and got all my labs done, so all clear to start.

Given this information-- late dose of Viread and Epivir, and starting AZT with it late in the regimen-- is PEP still warranted and effective? Why is PEP suggested if a partner insists we used condoms? If I cannot handle the AZT, would you suggest continuing to take it regardless or toss it and continue with Viread and Epivir only or manage side effects somehow?

Finally, what is the earliest conclusive test possible if PEP is unwarranted? A viral load test at 10 days?

Thanks for your help.

[Dr Sean Cummings]

Hello

Thanks for the post.

The overall risk to you per episode of unprotected receptive anal sex with a known HIV positive individual is around a maximum of 3%.

In this case, we don't know the status of the other man but apparently he is negative and if that is the case then your risk of HIV is zero.

Generally in terms of PEP triple therapy is advised - although you say you were issued the epivir and viread by a local clinic so it may be that this is their policy. We use Kaletra and Truvada.

Before starting PEP or very shortly within the first few days then you should have both and HIV test and also basic chemistry to make sure that your liver and kidneys are ok.

Taking PEP is a personal choice balancing the consequent delay in then getting an early and accurate HIV test and the side effects and also the uncertain nature of whether you have been exposed before.

In your particular circumstance the UK guidelines on use of PEP would be for you to start it.

I hope that helps. In addition of course you should have all the usual and other screens for other STD's. Whilst you are doing that please check to make sure you have been immunised against Hepatitis B and A.

Kind regards, Sean