HIV Exposure on PEP

[scared12468]

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.

[Edward W Hook, MD]

Welcome to the Forum.  I'm sorry to hear that your condom broke. This occurs about 1% of the time condoms are used.  You are fortunate however that this person was willing to tell you that you had been exposed to HIV- not all people would do this.  The risk of infection from your exposure is, from a statistical perspective, quite low.  The reason I say this is that the risk of infection, ON AVERAGE if one has unprotected vaginal sex with an infected partner is about 1 infection per 1000 acts of intercourse.  Your risk however is actually considerably lower than that because she is on effective therapy.  you can be sure that her therapy has been effective since her viral load was <250.  When studies have been performed they have shown that the lower the viral load, the less likely  infection is to be transmitted.  In one important study, there were no transmissions of infection when persons had <10,000 copies of virus- your partner's was far, far lower.  Further, another groundbreaking study  published in the past year indicates that HIV therapy reduces the risk of transmission more than 95%.  All of these data, therefore, suggest that your risk of infection is low.

In the overall scheme of things, while you have herpes, this does not affect your risk nearly as much as the fact that she is on therapy reduces it.  

Since the exposure was over a week ago, there is no role for antiviral post-exposure prophylaxis (PEP) in your case, even if you wished to pursue it (PEP is effective only within the first 72 hours after an exposure).  for better of for worse, there no much to be done at this point but wait and test.  At 4 weeks, a test using a 4th generation (combination HIV p24 antigen/HIV antibody) test will provide definitive results for you.  I anticipate that, at that time the test will be negative.  The odds are VERY much in your favor.  EWH

[Edward W Hook, MD]

The article you refer to is not this one. This article summarizes it.  many of the people in the study I mentioned however had multiple sexual exposures.

If you choose to argue with the data, that is your choice- the data, based on a high quality study, are the data and are believed by nearly all scientists in the field.   EWH

[scared12468]

Hi Dr Edward,

Is this the article you are referrring too:
http://www.aidsmap.com/HIV-treatment-may-prevent-at-least-nine-out-of-ten-transmissions/page/1437839/

This article is not clear to me in the fact that it does not state how often or not the couples in question practice unsafe sex clearly.
   Also, it states that when the HIV positive person did commence ARV's in the couple, they also began to practice safe sex more frequently..  Based on this point alone, how can it be reliably said that someone who si HIV positive that is taking ARV's is far less likely to be able to infect someone?

[scared12468]

Thankyou for your feedback.. I did however start PEP at exactly 19.5 hours after the exposure & have been on the medicine the whole week & will continue till 28 days is up. This I mentioned in my first post, but may not have made that clear.

I am still very nervous as there hasn't been anything in the way of real world studies done on HSV-2 making you more susceptible to HIV other than that article I posted in the first message..