Please help pep side effects and exposure risk assessment

[braziliangus]

Hello doc  I am male I had an intercourse with a shemale that was 100 per cent safe until the last 4 minutes where i am extremely anxious about the condom and if i was at risk. The facts are:
The condom did not broke at any time.
The condom slipped the tip off a tittle during intercourse but the gland was protected
And the problem is that at the final minutes i am not sure if the condom slipped further because when we finished i did not see the shemale taking it out. The condom was kind of stuck in my anus during the removal of the penis. My thought is that if the gland was at anytime exposed the condom would have come off and would be deeper in my anus and not with a traction that i felf when he was pulling out. Is that correct? can i base any decision in this informatio ?He / she said that the tip came out a little but it was ok. But i am scared to death if he / she was lying or unaware because we were both drunk and she was very wild and appeared drugged would not know adam from eve.  She had condoms in her purse thats a good signal but the never tested for hiv.
I asked her
Following that possible exposure i got pep azt and kaletra twice daily and currently on day 3 i cannot stand the side effects several times worse than anticipated. I want to stop but i am afraid of developing resistance for not following the regimen in a possible hiv contamination in the future. So

- whats the risk assessment of the exposure? I really missed the focusin the condom for 5 minutes
- if i stop pep now will develop resistance in future hiv problem?
If i got contaminated now and stop pep to only discover later in 30 days that i am positive, it will affect the efficacy of the possible contamination now?

If icontinue, the side effects tend to be worse in the first days or not? I cannot find information about this especifically.
Side effects: nausea diarrea, tiredness , cant even get up from the bed. Really really sic
Thank you

[Edward W Hook, MD]

Not much beyond what I've already said.  Taking the meds in the evenng is helpful.  Hope all works out for you.  EWH

[braziliangus]

Thank you doc i will keep the pep regimen and see if i survive lol. Could you give me any more hints of coping with the meds? I am taking an antiemetic medicine for nausea but still pretty bad and a lactobacillus to reconstitute the intestinal flora. Thank you

[Edward W Hook, MD]

Welcome back to the Forum.  It is not clear to me if the condom came off during sex or as your partner removed himself from your rectum.  If it was the latter, this was a no risk event for which PEP was not needed.  If it was during sex, then if your partner had HIV PEP is a good idea but as you acknowledge, you do not really know if your partner had HIV or not, thus the need for PEP is very unclear.

Your experience however is not unusual for persons who take PEP.   About half of persons who take PEP experience side effects which lead them to not take PEP for the entire recommended duration of therapy.

As for your specific questions:
1.  - whats the risk assessment of the exposure? I really missed the focusin the condom for 5 minutes
See above.  If your partner has HIV your risk of infection, if the exposure was unprotected is about 1% (1 out of 100).  As I said above, if the condom came off as he withdrew, there is no risk.


2. if i stop pep now will develop resistance in future hiv problem?
If i got contaminated now and stop pep to only discover later in 30 days that i am positive, it will affect the efficacy of the possible contamination now?

No one is sure precisely how long PEP needs to be taken to offer its full protective effect.  Resistance to the antiviral therapy of PEP develops most commonly when persons only take one medication at a time and if they take medications irregularly.

3.  If icontinue, the side effects tend to be worse in the first days or not?

Typically the side effects for most people become less troublesome over time and the medication is easier to take.  Most people take the medication at night, just before going to sleep as well.  This tends to reduce side effects too.

I hope this helps.  Your decisions would be much easier if you can find your partner and have them tested.  If s/he is HIV negative at this time there is little reason to take PEP.

I hope these comments are helpful.  EWH

[braziliangus]

I understand that my exposure was not a full blown clear pep recommended exposure but i thought " i want to overcome this problem " but now with the side effects the cost benefit of the decision is not clear and now i am worried about the potential consequences of stopping pep on day 3 thanks agaim