Super Scared and PEP

[concernedinnyc]

hi.  i am hoping i can get some information from you. your site is an incredible service.  

last night (about 14 hours ago) i was with an anonymous sex partner.  i did ask his hiv status and he did say he was negative with a test about 2 months ago.  But i dont know him.  ON 3 seperate occassions i let him insert his penis inside me and then each time i pushed him out.  this was without a condom.  we then later used a condom for sex - i was receptive anal.  my exposure is the 3 times i let him put it inside me which i understand has risk for HIV.  I am horribly ashamed of my lack of judgement, but it is what it is.  though these were brief encounters and there was no coming, i still no there is risk.

i am just now about to take my first PEP medication.  I understand the side effects will be terrible and i am sure i will not be the exception here.  these are my questions:

1.  what do we know about the effectiveness of PEP taken about 15 hours after exposure?  How effective is this?

2.  i know this was high risk behavior, what are my chances of risk from this.....i am scared.  but dont sugar coat it for me,

3.  PEP is only for 28 days  -which will seem an eternity.  but why are the confident that is as long as you need to take it?

4.  can i rely on a test such DNA PCR within this period of time to look for the virus so i then dont have to complete the regime?  or does PEP mask the tests in any way?

thanks so much.  anxious to hear from you.

[H. Hunter Handsfield, M.D.]

Sorry, those are questions for the provider who prescribed PEP.  You have my assessment about the low risk you were infected.

HHH, MD

[concernedinnyc]

Dr.
I am starting to freak out.  thanks for your message but i am hoping you can respond to a few more questions.  I am starting to read on the web and i am nervous that i am positivie from this one episode of potential pre-*** in my anus in case he was recently infected.

1.  you mentioned a guess of 1/1000.  does this go up considerably if he had a new infection?  just from possible pre-*** exposure that was brief?

2.  what is the soonest someone can take a DNA-PCRA test and have it be reliable?

3.  the side effects of the drug have diminished and its no big deal to stay on them, but i am super concerned they are not going to work.

thanks!

[concernedinnyc]

thanks for your comments.  i am taking both truvada in the am and sustiva at night.  sustiva is HORRIBLE.  this is a tough tough drug.  I am hoping to actually not take this one and will talk to my doc next week.

you said you would huess pretty low risk, around 1 in 1000, even if he had a new infection.  this is also what i think.  But i am curious as to why?  have you known people to be infected with just this kind of exposure or do they usually have ejaculation and or a longer duration of time being inside the person?

there was something about this guy that i am not conformtable trusting that he didnt lie. while i dont think he was positive and lied, i do think he probably doesnt know....if he does this with me, i think he does this alot.  

if i was infected i REALLY hope this works.  i am so scared.

[H. Hunter Handsfield, M.D.]

Any receptive anal sex with a partner of unknown status is technically a high risk exposure, but with such brief exposure without ejaculation, the actual risk was pretty low risk, especially with your partner's assertion that he tested HIV negative 2 months earlier.  Of course it's not foolproof, but most people don't lie when asked directly, and the odds are slim he was in the window period.  On the other hand, if he did happen to have a new infection, he would have been highly infectious due to high viral load.  Prescribing PEP in this situation is a judgment call, and I would not have recommended it--but now that you're into it, you should follow through and adhere to your provider's advice.

Your provider is the one you should be asking all these questions.  I do not personally care for patients on PEP; your provider probably more about it than I do.  1) My understanding is that PEP should be highly effective when started within 15 hours.  2) As a guess, the odds you were infected (even without PEP) are no higher than 1 in 1000.  3) To my knowledge, shorter periods of PEP simply have not been studied.  Because the research is with 28 days, that has become the standard interval.  Less intensive treatment might work, but in the absence of data, I would not recommend it.  4) I am unaware of data on the effect of PEP on PCR testing.  It makes sense a positive test, if PEP fails, might be delayed, but you will need to rely on your provider for this one.

Good luck--  HHH, MD