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Truvada for PEP
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This forum is limited to prevention of HIV and to safe sex in general. All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Truvada for PEP

Doc, apologies if this question has been asked before.  My partner is HIV+ with an undetectable viral load for 18+ months now.  We had a condom breakage incident - he withdrew (I was receptive) in less than a minute, and did not ejaculate.  He doesnt ever seem to have precum (for what that's worth).  I went to an urgent care and was prescribed Truvada for 28 days, and took the first pill 24 hours post exposure.  I've been reading (often a bad idea) that effective PEP typically contains both Truvada and some other drug - apparently the low viral load played into that decision (if I recall correctly).  Does that seem reasonable to you, and do you think Truvada alone is sufficient given my exposure?

thanks
239123_tn?1267651214
Welcome to the forum.  Thanks for your question.

My first thought is that I'm not at all certain PEP is warranted in this situation. This is always a judgment call, and an argument can be made for it.  On the other hand, the data suggest that people with undetectable viral load rarely if ever transmit HIV.  The reduction in risk is so great that 2-3 years ago the public health authorities of Switzerland transiently had a formal policy that HIV infected persons on effective ART didn't even need to use condoms.  Needless to say, that was very controversial and raised eyebrows among HIV and public health experts worldwide, and they backed off.  But it does illustrate the level of safety conferred by ART with effective reduction in viral load.

But as I said, PEP decisions always involve judgment, and perhaps this was the right decision for you.  On the other hand, I would suggest you confirm that decision, and decide whether or not to continue with PEP, with an HIV/AIDS expert, such as an infectious diseases specialist -- rather than relying entirely on an urgent care provider who may not be a real HIV expert.

And that leads to my final comment, in response to your initial question:  I would not presume to prescribe specific PEP therapy.  Truvada alone often is used, and I don't personally know the pros and cons of adding other agents.  This is an issue for discussion with the HIV/AIDS specialist I hope you will see -- along with a final decision about whether you need PEP at all.

In the meantime, don't be seriously worried.  Even with entirely untreated HIV, the average transmission risk through unprotected anal sex is around once for every 200-500 exposures, so even if your partner weren't on PEP, with such a brief exposure after the condom broke, your risk would be lower still.  All things considered, you are at very low risk, even without PEP.

I hope this has helped. Best wishes--  HHH, MD
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University of Washington
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