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HIV RIsk after condom broken /PEP
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HIV RIsk after condom broken /PEP

Dear Dr,

Monday 5 october 2010 5pm I took a risk with a sex professional in germany in a sex house:
Woman is from thailand.
Condom rupture at the end of the intercourse with ejaculation 15seconds unprotected sex: immediate cleaning
The professional claims to do tests and to not have any diseases, I can only believe her words and believe as a professional she is not a kamikaze. She said she made test in September 10 and because she has a little girl she cannot take risk...

Next day,6 th october, I went to hospital, met a Aids specialist, told me yes I had a risk and I received combivir + viramune 4 days then he told me to only take combivir for the last remaining 24 days of treatment.

This day I was checked and no HIV/siphilis/hepatits detected on the 6th of october.
Everything else good, ALAT, SGPT etc.. Treatment started 16 hours later after risk. I do take a lot of vitamin B, ginseng and selenium especially before winter.
*Do i need to worry to get HIV even with the prophylaxia started before 24 hours ?
*Is the less duration to exposure (15 seconds) a good factor to avoid HIV ?
*I know there is a risk of 0.03% to 0.05% per intercourse with infected girl to get it, will prophylaxia reduce that risk ?
*I received combivir + viramune 4 days. After that period, only combivir for the last remaining 24 days, will there be same efficacity as if it was a tritherapy? I am now in the 15th day of the treatment and did not notive any upcoming other ST (clamidia etc..).
*Will Agp24 negative be a good sign ?- I have to do it next week.
*Is absence of ARS symptoms during the first month a good sign ?
*Based on your experience of some patients you have followed with prophylaxis, how many seroconverted and how many did not?
*Will the post treatment delay a possible seroconversion ?

Im sorry to post a bunch of questions but they are all linked to that problem and currently I feel very anxious.

Thank you very much !
Best Regards
Harvey
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1024580_tn?1331577721
Hello Harvey,
Thank you very much for your posts and my apologies for not having received an answer sooner.  All in all, I have to say, that your risk of having contracted HIV is very low in the case of this lady being positive, but obviosuly there is some risk and I can understand why you were given that PEP regime.  I am going to try to answer each of your questions here below:
*Do i need to worry to get HIV even with the prophylaxia started before 24 hours ?

AS MENTIONED BEFORE, I DO NOT BELIEVE THAT YOU PUT YOURSELF AT A HIGH RISK OF HIV INFECTION; I DEEM THE RISK TO BE VERY LOW.  HAVING STARTED PEP WILL REDUCE THAT EVEN FURTHER.  I BELIEVE THAT YOU DO NOT NEED TO WORRY AND THAT YOU ARE GOING TO BE FINE.  tHE FACT THAT YOU HAVE NOT CONTRACTED ANY OTHER STD, IT IS EVEN LESS LIKELY THAT YOU WOULD HAVE BEEN INFECTED WITH HIV WHICH IS FAR RARER AND LESS INFECTIOUS THAT, LET'S SAY, CHLAMYDIA OR GONORRHOEA.

*Is the less duration to exposure (15 seconds) a good factor to avoid HIV ?

THE SHORTER THE PERIOD OF EXPOSURE, THE LOWER THE RISK.  THEREFORE, YES, IT IS A GOOD SIGN.

*I know there is a risk of 0.03% to 0.05% per intercourse with infected girl to get it, will prophylaxia reduce that risk ?

YES, IT WOULD. THAT IS WHY IT IS PRESCRIBED.  UNFORTUNATELY THERE ARE NO RELIABLE FIGURES AS OF THOSE PATIENTS TREATED WITH PEEP, WE DO NOT KNOW HOW MANY WERE INDEED INFECTED IN THE FIRST PLACE.

*I received combivir + viramune 4 days. After that period, only combivir for the last remaining 24 days, will there be same efficacity as if it was a tritherapy? I am now in the 15th day of the treatment and did not notive any upcoming other ST (clamidia etc..).

IT IS A DIFFERENT REGIME TO THE ONE THAT WE USE, BUT I THINK THAT IT HAS GOT A SIMILAR EFFICACY.

*Will Agp24 negative be a good sign ?- I have to do it next week.

IT IS A GOOD SIGN INDEED, BUT IT IS NOT BY ANY MEANS CONCLUSIVE BECAUSE THE ANTIRETROVIRAL MEDICATION CAN AFFECT THE RELIABILITY OF THESE TESTS

*Is absence of ARS symptoms during the first month a good sign ?

YES, INDEED.  IN MY EXPERIENCE, IF PEP FAILS, PATIENT CAN STILL EXPERIENCE SYMPTOMS OF SERO-CONVERSION.  HOWEVER THESE SYMPTOMS CAN ALSO BE DELAYED BY THE MEDICATION AND IT IS NOT A RELIABLE SIGN.

*Based on your experience of some patients you have followed with prophylaxis, how many seroconverted and how many did not?

I AM SORRY BUT I DO NOT HAVE FIGURES.  HOWEVER THE VAST MAJORITY TESTED NEGATIVE, POSSIBLY LESS THAN 3% TESTED POSITIVE AND MOSTLY WAS BECAUSE THEY STARTED PEP TTO LATE OR COULD NOT COMPLETE THE FULL COURSE.  IT IS DIFFICULT TO ASSESS HOW EFFECTIVE PEP CAN BE, BECAUSE WE CANNOT ASCERTAIN HOW MANY PATIENT HAD ACTUALLY BEEN INFECTED BEFORE THEY STARTED PEP

*Will the post treatment delay a possible seroconversion ?

YES, THAT IS WHY THE RELIABILITY OF ANY SUBSEQUENT TEST WILL BE DELAYED AFTER FINISHING PEP, NEEDING TO WAIT UP UNTIL 12 WEEKS POST-PEP.

Best wishes,
Dr José
5 Comments
Blank
Avatar_m_tn
Hello

maybe I was forgotten? May I get an answer to my question?
thank you
regards
Harvey
Blank
Avatar_m_tn
Hello

maybe I was forgotten? May I get an answer to my question?
thank you
regards
Harvey
Blank
Avatar_m_tn
Dear Dr Mervyn Tyrer,

Monday 5 october 2010 5pm I took a risk with a sex professional in germany in a sex house:
Woman is from thailand.
Condom rupture at the end of the intercourse with ejaculation 15seconds unprotected sex: immediate cleaning
The professional claims to do tests and to not have any diseases, I can only believe her words and believe as a professional she is not a kamikaze. She said she made test in September 10 and because she has a little girl she cannot take risk...

Next day,6 th october, I went to hospital, met a Aids specialist, told me yes I had a risk and I received combivir + viramune 4 days then he told me to only take combivir for the last remaining 24 days of treatment.

This day I was checked and no HIV/siphilis/hepatits detected on the 6th of october.
Everything else good, ALAT, SGPT etc.. Treatment started 16 hours later after risk. I do take a lot of vitamin B, ginseng and selenium especially before winter.
*Do i need to worry to get HIV even with the prophylaxia started before 24 hours ?
*Is the less duration to exposure (15 seconds) a good factor to avoid HIV ?
*I know there is a risk of 0.03% to 0.05% per intercourse with infected girl to get it, will prophylaxia reduce that risk ?
*I received combivir + viramune 4 days. After that period, only combivir for the last remaining 24 days, will there be same efficacity as if it was a tritherapy? I am now in the 15th day of the treatment and did not notive any upcoming other ST (clamidia etc..).
*Will Agp24 negative be a good sign ?- I have to do it next week.
*Is absence of ARS symptoms during the first month a good sign ?
*Based on your experience of some patients you have followed with prophylaxis, how many seroconverted and how many did not?
*Will the post treatment delay a possible seroconversion ?

Im sorry to post a bunch of questions but they are all linked to that problem and currently I feel very anxious.

Thank you very much !
Best Regards
Harvey
Blank
Avatar_m_tn
Dear Dr Jose

I am sorry fo have posted same message twice, seems there was a little issue..
anyways thank you very much for you details !

Today I went back to my hiv specialist, I asked him what are my odds he replied:
you have a risk of less 1% probably 0.5% and maybe a bit less with the PEP. How can such a specialist not being aware of reliable numbers we can easily find everywhere or is it a plan to scare people? -CDC figure: 0.005%

1. He told me also during first month of PEP it is useless to test vih, i asked for PCR he said that does not make sense during PEP. He recommended me to wait 1 month after the 28  days of PEP to get a reliable test. Does that make sense? Can we not be sure just after first month?

Aside this I dont experience any side effects, my blood is checked every 15 days for liver modification.

Hopefully he did tell me he has not seen any seroconversion occured after PEP so far which I take as a good sign.

2. 17 days after exposure I don't seem to have symptoms of gonorrhea, clamidia, what is  incubation time? I have read symptoms must happen int he first week if infected, right?

3. Finally you do think I have to stop to worry and that I will not get HIV ? I have obtained a reply from Dr hunterfiled, forum HIV prevention, he said my risk is zero , I might even not seek hiv test, do you agree?

Best regards
greetings from France
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