Freaking Out...Possible HIV Exposure

[silvershadow14]

This past New Year's Eve I got really drunk and ended up in a place that men go to "play."  It was my first time having sex in a place like this and my first time penetrating another man.  I've never been penetrated.  My usual interaction with men is limited to receiving oral and occasionally analingus (receiving).  In this particular encounter, I was the top, but thru the very brief course of our encounter I had some issues inserting my penis...I kept popping out.  A condom was used, but on my last re entry, the condom slipped off at some point, which I did not realize until I pulled out for the last time.  I suffer from premature ejaculation, so this entire interaction encounter  lasted  about 2 minutes…including me popping out.  Unfortunately there was some feces on my shaft.
The guy said that he believes that he is clean and that I don't have anything to worry about.  I asked him the last time he was tested.  He said he's been tested multiple times over the last 5 years and he's been clean every time, but his last HIV test was about 2 years ago.
When I got home, I discovered some info on PEP.  I went to Urgent Care later that day.
I was prescribed PEP (I take 2 pills (zidovudine and epivir) in the am and the same 2 pills in the pm).
I usually do not engage in high risk behavior AT ALL, so I am worried scared.  I've NEVER been penetrated and this was my first time penetrating. I’ve never had an STD before.  I had a complete STD workup about 6 months ago.  Everything came back fine.  Since then, this has been my first non-oral sexual encounter.
I started the PEP treatment about 16 hours after. I’m on Day 5.  Side effects have been negligible.  
I am freaking out.  Going to work is even a struggle.
My questions are: Was PEP the right decision given this circumstance? When do side effects from PEP usually begin? Given this situation, what factors should I be mainly concerned about regarding the risk of my potential exposure to HIV?

[Edward W Hook, MD]

1.  12 weeks following completyion of PEP
2.  No, I would be more positive.  It works althught precisely how well (i.e. preventing half, 75% , 90% of infections is a bit less clear)
3.  Rarely. With rectal intercourse, IF your partner was infected, about once in 100 exposures.  EWH

[silvershadow14]

So this morning I took my last dose of PEP...I really had VERY little side effects - minor fatigue and slight headaches. Nothing unbearable.  In that aspect I am very blessed, but still am freaking out.  Have horrible night mares and trouble sleeping.  I also abstained from drinking while taking it (well, until the last day) because I heard that it could decrease the tolerance of the meds.  I do have a few questions:

1.  Now that I've completed the treatment, when should I get tested?  12 weeks after exposure or 12 weeks after PEP completion.

2.  Right after I started taking PEP, I went to see an infectious disease physician because you stated in your initial reply that PEP should be taken under the guidance of a doctor.  But he just told me to come see him after I'm done with PEP.  He also said that the evidence that it works is hit or miss.  Is this correct?

3.  I am aware that HIV can in fact be transmitted through a single exposure.  How often does this occur?

Thanks in advance for your help Drs.

[Edward W Hook, MD]

PEP is highly effective.  To try to tell you how effective is hard to do since most exposures do not lead to infection.  This if your moderate risk was in the neigborhood of between 1 in a thousand and 1 in one hundred, PEP would make in at ten times and probably more less likely.  

I understand your stress.  You've done things right.  Now you need to wait for the tests.  I am confident that, given the steps you've taken, they will be negative.. EWH

[silvershadow14]

Thank you kindly for your prompt response.  Can you provide a little more detail when you say moderate?  

And from your experience, exactly how effective is PEP if exposed to HIV?

And let me conclude by saying that I am not one of those people who will spam you with 50 questions on one post.  This will more than likely be my last round of questioning, it's just that I am very nervous and a high degree of stress and anxiety has set in.

[Edward W Hook, MD]

Welcome to the Forum.  While in my opinion PEP is overused by person with negligible risk, in your case I think it was a reasonable option.  You had insertive rectal sex with an anonymous partner who had not had an HIV test in two years. His presence at the site you met suggests he may have had other anonymous partners as well.  I would not say your risk is high but moderate.  Having made the decision to take PEP, you also i the correct thing by starting it ASAP after your exposure.  PEP has little effect more than 72 hours following exposure.  It also sounds as though you are tolerating your therapy well - most side effects from PEP start relatively soon after taking it. Should you develop a rash, abdominal pain, or develop jaundice it would be good to go see your doctor for evaluation.

PEP is highly effective for HIV prevention if you were exposed.  Nonetheless, after completion of PEP, you should be tested.  While the frequency with which such testing is recommended varies, most authorities would agree that you need to be tested out to 12 weeks following exposure to be totally sure that you did not get HIV.

PEP should be taken under the guidance of a doctor who can see you repeatedly while you are taking it.

I hope these comments are helpful to you.  EWH