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HIV Exposure on PEP
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HIV Exposure on PEP

As I type this I am shaking in fear.. I really need your Professional advise on this.

On Saturday morning last week  I met a girl in Cambodia. After a few drinks together I took her back to my hotel & we had sex. I used a condom throughout the intercourse, however, after I ejaculated & pulled out I noticed the condom broke. It must have broke near the end as when we changed positions I noticed it was intact each time. 17 hours later after the incident she sends me an sms telling me she is HIV positive. I rushed to the  best hospital I could find in Cambodia & at 19.5  hours initiated PEP treatment with the drugs Truvada & Kaletra..

More information

- During the intercourse the foreplay consisted of alot of kissing. I have an ulcer in my mouth.. i asked if she has any ulcers or sores in her mouth & she said she has nothing.

-  She is on AVRS for last 5.5 Months (Since February 9 2012) . She takes a tablet twice daily & each tablet contains Lamivudine USP 150mg, Stavudine USP 30mg & Nevirapine USP 200mg

- The Day after I get a CD4 count & Viral load done for her. Results are the following

CD4 count is 349 (5.5 months ago it was 223)


Viral load was UNDETECTABLE. However the assay used is from Biocentric & the limit of detection = 250 copies/ml (2.4log10). & the result given is <250.

Also got her to do the following tests:

Chlamydia via swab = Negative
Gonorrhea via swab = Negative
Herpes type 1 & 2 via blood = Still waiting for result

I know that other STD's can increase the chance of getting HIV.  My biggest worry is the following article that clearly highlights a 2-3 times risk with people who have Genital Herpes even when healed.  I HAVE Genital herpes & only just recovered from it about 3-6 days previously.

http://www.emaxhealth.com/1020/53/32605/even-healed-genital-herpes-increases-hiv-risk.html

Please can you give your feedback on this in regards to my risk level, particularly given I have Genital Herpes. Extremely worried about this.
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Hello,
Thank you for your post and welcome to our forum.  Apologies for not having replied sooner, but I am afraid that we are extremely busy doctors.
All in all, I would say that the risk of HIV infection to you is low, even knowing that the lady in question is HIV positive.  Firstly her viral load is undetectable (even with a threshold of 250 copies/ml- which is a very low level anyway) and thus she would not be infectious, not putting you at risk, regardless of the fact that you suffer from genital herpes.  The increased risk of transmission would be in the case of a high viral load, and usually when having an acute outbreak in the presence of unhealed herpetic lesions on your genitals.  This was not your case either.  Furthermore, most of the penetration was protected.  The shorter the time of exposure, the lower the risk.  The fact that she became pregnant would not increase the risk of transmission to you.
In summary, your estimated risk is well below 0.1%, and you have started PEP at the correct time period.  Therefore I am pretty sure that you are going to be absolutely fine.
Best wishes,
Dr José
8 Comments
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Avatar_m_tn
Futher information.. The girl in question just advised me that she has not had her period yet (3 days overdue). She thinks she may be Pregnant.  

However she said her period is always starts on the days 6-8th of each Month.. Based on this, during June her period of fertility should have been Wednesday, 20 Jun, 2012  to Monday, 25 Jun, 2012. We had sex on 1st of July. It does not seem possible she is pregnant.  Either way, pregnant or not she does not want to keep if she is pregnant.

Does above in anyway increase my risk factor?

I really hope to get some sort of reply in this forum tonight
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Avatar_m_tn
I've waited patiently for a reply from one of the 2 doctors on this forum for days, but nothing.  Can someone please reply.  
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Avatar_f_tn
I'm not a doctor, but I am someone who is also scared of HIV exposure. I've done a lot of research and I don't think the internet is the best way to get information. See a doctor in person. You can also call the CDC hotline: 800-458-5231.
Good luck to you , I hope everything works out for you.
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Avatar_n_tn
If it makes you feel better, Dr. Hansfeld and staff have won numerous awards, etc. for accuracy of information on this site.

If they say your risk is well below .1% (i.e. less than 1/1000) then it's pretty darn low.

I will remind you that the HIV transmission rate for unprotected insertive sex with an infected partner is at most 4/1000.  (http://en.wikipedia.org/wiki/Vertical_transmission_of_HIV#Perinatal_transmission).  Considering this woman apparently takes medication to treat HIV, and you said it says her viral load is "undetectable" this means she has much, much less than the normal rate.

If you read the literature carefully, you will see the most common mode for infection is: "unprotected, vaginal or anal intercourse, within 6 weeks after infection".  Particularly, this is because after infection, viral rates go up to 1000x normal, but the body has not made antibodies that are detectable under most bloodtests used to detect HIV infection.  While you did have vaginal intercourse, this was mostly protected, and the rates are not 1000x normal; in fact, they are the exact opposite, "undetectable" means pretty darn low to me.

If it helps you feel better, an HIV infected person can have repeated unprotected sex with a partner, and conceive a child without giving the child or partner HIV, IF the infected person TAKES MEDICATION (which your girl did).

I would say the use of a condom (even if not complete), combined with her using medication correctly and consistently (down to a viral load of "undetectable"), and your use of PEP makes it as low risk as averted.  The most important thing to be thankful for is that she knew her status, was getting treated, and she had the courage to tell you.  I wish we all could be so good as her.

Granted, if I was in your shoes, I'd be sweating bullets (everyone would be).

Assuming you did not get it, please be sure to post positive experiences and donate money/ do what you can to keep this forum going, as it helps take down a lot of unncessary anxiety and give good information.
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Avatar_f_tn
Hi 2 every1 .can anybody tell me dat should i be relax for the tests that i did .i tested rapid spot test at 40 days after exposure and again a rapid test after 52 days and d laday uhat i slept with her did nt have sex for 1 year after her husband death and she also tested 2 times with spot and hiv 1 and hiv 2 screening and our all results were negative and as for i m concern i never had sex with some1 in my life and she also did nt do for d last 11 months and today i testd wid elisa combo antigent and p24 and anti body after 80 days and it was negative so my question is that should i stil worry and think to hiv ?i dont have any sympoms but only lost my weight and it i think is because of tension and cannt having food properly becoz of tension so plz if there s any expert tell me it s conclusive 4 me to test or nt
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Avatar_f_tn
Hi 2 every1 .can anybody tell me dat should i be relax for the tests that i did .i tested rapid spot test at 40 days after exposure and again a rapid test after 52 days and d laday uhat i slept with her did nt have sex for 1 year after her husband death and she also tested 2 times with spot and hiv 1 and hiv 2 screening and our all results were negative and as for i m concern i never had sex with some1 in my life and she also did nt do for d last 11 months and today i testd wid elisa combo antigent and p24 and anti body after 80 days and it was negative so my question is that should i stil worry and think to hiv ?i dont have any sympoms but only lost my weight and it i think is because of tension and cannt having food properly becoz of tension so plz if there s any expert tell me it s conclusive 4 me to test or nt
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