Actual receptive oral exposure to HIV POZ source, PEP

[strata]

'm a 30yo bi-male who had a recent receptive oral exposure to an HIV+ source. I came into contact with pre-ejaculate but not semen/ejaculate. I am currently 3 weeks post-exposure and taking nPEP (started 24 hours post-exp).

I originally posted in the Dr HHH-monitored HIV Prevention forum:

http://www.medhelp.org/perl6/HIV/messages/696.html

I tested negative at day 18 using finger stick OraQuick. I'm awaiting results from the whole blood ELISA and PCR DNA/RNA taken same day.

Here are my questions:

Have any members of this forum...

1) ...contracted HIV from receptive oral with a man (i.e., giving a blow job)? Was ejaculation involved? Were there any aggravating factors (oral pathology, e.g., periodontal disease, gigivitis, etc.)?

2) ...contracted HIV despite the use of PEP? If so, what was the exposure? When was PEP started? Was the full 28-day course completed?

3) ...experienced negative health outcomes from the use of PEP (e.g., liver damage)?

4) ...tested HIV+ after having initially tested HIV- at less than 6 weeks?

There are a few reports of HIV transmission from oral sex, but the most reliable reports involve some sort of oral pathology. There are several questionable reports or oral transmission of HIV because riskier acts from the same exposure (e.g., unprotected receptive anal sex) are often under-reported (as revealed after multiple follow-up interviews). Consequently, it's hard to get a feeling about the 'true' risk.

Dr HHH handicaps my risk as 1/500,000.

My est: 1/10,000 * .2 (PEP) * .5 (3wk HIV-) = 1/100,000.

Still nervous...

[Teak]

As long as you are taking PEP, your tests can not give you a correct result. You will always test negative with PEP. PEP prevents the body of manufacturing antibodies. You will need to take your ELISA test 13 weeks post the last dose of PEP.

[strata]

PEP does not prevent the creation of antibodies; in HIV-infected patients ARVs (same drugs used for PEP) impact viral replication (and therefore overall viral load), but antibody production is unaffected. Most research suggests that it also does not delay seroconversion (there have been limited instances of delayed seroconversion in animal studies and HCW cases, but most cases seroconvert within the statistical margin of error for non-PEP treated patients). Dr HHH and Dr Bob at thebody.com also share this view.

[Teak]

I don't know where you are getting that kind of information but it is incorrect. If a person were to mfg antibodies then they are positive. The PEP is use to prevent the production of antibodies by killing the virus and prevent replication and then no antibodies. Anyone that has detectable amounts of antibodies is HIV positive.

[freddy999]

I think Strata's point is that if PEP does not work on this occasion then antibodies would be produced either in the normal expected timeframe or slightly longer due to the delay in viral replication that may have occured by administering PEP. If PEP does work/ is working then I agree with Teak, No antibodies will ever be present.

Therefore the only way to know for sure, at least the general consensus, is to test for antibodies 3 months after the cessation of PEP. i.e. 4 months after exposure

[cholny29]

I had read on the aidsmeds site that there have been no documented case of hiv transmission by fellatio for a female giving receptive oral to a male and there have been only 3 documented cases of males contracting hiv from giving each other fellatio.  Why do you think there is so much difference between the males and females? Do you believe these numbers are accurate? thanks!

[peekawho]

Search the HIV forum archives a bit.  I did find this from Dr. HHH:

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"My guess is that there are no systematic studies, and therefore no definitive data, on the influence of PEP on speed of seroconversion. Hence the noncommittal responses from your GUM providers as well as from me."
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He indicated in a few posts that if it has an impact on seroconversion, he guesses it is minimal but admits this is not his area of expertise.

[Brian123]

I think you will be ok...and negative.

My friend who lives in NYC, had a similar situation like yours...and tested negative.
He performed fellatio on a male who later told him (one month later) after seeing him at a club, that he was HIV+.
My friend freaked out.....got tested...(one month) and it was neg.
Three months later....negative.

You will be fine....at least with the minimal exposure to the semen reduced your chances SIGNIFICANTLY!!!

To be honest, the mere fact that you knew he was + is what is scaring you the most.
The actual risk is basically null.

[strata]

You asked why there is such a "difference" between HIV transmission rates for receptive penile-oral sex for men and women. Here are my thoughts:

1) I think there have been many more REPORTS/CLAIMS of HIV transmission by oral sex, but not all of these have been documented in the medical literature. The resident at the ID clinic I'm seeing for follow-up knows of 2 patients (men) whom he believes contracted HIV from receptive oral sex.

2) Even if your numbers are correct (men 3, women 0), this difference would not be statistically significant.

3) The studies of oral sex that HAVE been done have shown that MSM who initially claim oral sex as their only exposure often under-report riskier behaviors, such as unprotected receptive anal sex. The theory is that there is a significant amount of guilt/other psychological trauma associated with admitting a very high risk behavior (unprotected receptive anal sex) when we're 20+ years into an epidemic and profligate messages about safe sex and the risk of certain behaviors.