Aa
Urgent question - exposure to HIV
Hi, very quick but urgent question. Last night I had unprotected sex with a female sex worker in Bangkok. Quite cleary I am regretting the action this morning. I am well inside the timeframe to see a doctor about getting PEP. My question is with the exposure I have had would you recommend using PEP, I have read a lot of the forums but I haven't see a question this direct answered so far. Can you please reply very soon, I only have a couple of hours to wait. Thank you. Jason
Hi. Sorry about the delay in replying.
In a nutshell - you've made an (arguably incorrect) decision to take PEP. However, now that you've made it; suck it up and stop second-guessing the decision; you'll drive yourself nuts.
To answer your questions in no particular order.
- the PEP side effects are likely to lessen with time.
- In terms of risk - in "HIV speak", a one in a hundred chance of transmission is referred to as "high" risk. You didn't have anything like that, statistically speaking. That said, statistics are only useful as far as the individual is concerned in determining a management pathway - ie, in your case, the risk-benefit equation of taking PEP. As I said above, in your case the decision was arguably incorrect on the basis of the global risk-benefit-o-meter - but you've made a decision to do it; we can all sympathise with why you did, so stick with it.
- Individual sexual acts are indeed low risk. There is a lot of HIV around because there's a hell of a lot of sex going on. It's as simple as that.
- I once talked to an HIV specialist in a major HIV centre in Canada. He reported that even people who have had a high risk exposure like a needle stick with definitely infected blood, occasionally choose not to take PEP - because the side effects are so great and the risk of transmission so small. Not a course of action you or I would take; but might help get your risk in perspective?
Hope this helps.
In a nutshell - you've made an (arguably incorrect) decision to take PEP. However, now that you've made it; suck it up and stop second-guessing the decision; you'll drive yourself nuts.
To answer your questions in no particular order.
- the PEP side effects are likely to lessen with time.
- In terms of risk - in "HIV speak", a one in a hundred chance of transmission is referred to as "high" risk. You didn't have anything like that, statistically speaking. That said, statistics are only useful as far as the individual is concerned in determining a management pathway - ie, in your case, the risk-benefit equation of taking PEP. As I said above, in your case the decision was arguably incorrect on the basis of the global risk-benefit-o-meter - but you've made a decision to do it; we can all sympathise with why you did, so stick with it.
- Individual sexual acts are indeed low risk. There is a lot of HIV around because there's a hell of a lot of sex going on. It's as simple as that.
- I once talked to an HIV specialist in a major HIV centre in Canada. He reported that even people who have had a high risk exposure like a needle stick with definitely infected blood, occasionally choose not to take PEP - because the side effects are so great and the risk of transmission so small. Not a course of action you or I would take; but might help get your risk in perspective?
Hope this helps.
I would love to stop taking the PEP, to be honest it is totally knocking me out, I am dizzy and nauseous for about 4 hours each time I take the tablets.
But I can't quite work it out. If after unprotected sex with a sex worker I have only a "very very very small chance of contracting HIV" then why is HIV so prevalent? It seems like such a high-risk situation, how can the spread of HIV be described as rampant in recent times (I read that perhaps 40% of Chiang Mai sex workers are infected) if it so so difficult to catch? This is the only reason I am continuing to take PEP, I would love to be talked out of it, it's a horrible thing to take.
It just doesn't seem to balance, that having unprotected sex is considered high-risk, but the chance of contracting the disease is "very very very small". How does the equation work?
I am genuinely confused, and would love to have a reason to give the tablets back to the hospital, I am wondering how I will survive 4 weeks of these side effects. Can you help me understand - in one ear I hear high-risk, in the other ear I hear extremely low possibility, it is the inability to balance these statements that causes so much anxiety and confusion, not just for me, for everyone I think.
But I can't quite work it out. If after unprotected sex with a sex worker I have only a "very very very small chance of contracting HIV" then why is HIV so prevalent? It seems like such a high-risk situation, how can the spread of HIV be described as rampant in recent times (I read that perhaps 40% of Chiang Mai sex workers are infected) if it so so difficult to catch? This is the only reason I am continuing to take PEP, I would love to be talked out of it, it's a horrible thing to take.
It just doesn't seem to balance, that having unprotected sex is considered high-risk, but the chance of contracting the disease is "very very very small". How does the equation work?
I am genuinely confused, and would love to have a reason to give the tablets back to the hospital, I am wondering how I will survive 4 weeks of these side effects. Can you help me understand - in one ear I hear high-risk, in the other ear I hear extremely low possibility, it is the inability to balance these statements that causes so much anxiety and confusion, not just for me, for everyone I think.
No, no reduction in risk by having the test beforehand.
The "correct" answer is you should not have PEP for this exposure. The risks and cost of PEP are not great, but they are higher than your very very very small chance of contracting HIV. If everyone in your position was given PEP, we would end up doing more harm than good overall.
But in the end it's your decision, and we can all sympathise with why you'd want to go ahead with PEP at this point.
The "correct" answer is you should not have PEP for this exposure. The risks and cost of PEP are not great, but they are higher than your very very very small chance of contracting HIV. If everyone in your position was given PEP, we would end up doing more harm than good overall.
But in the end it's your decision, and we can all sympathise with why you'd want to go ahead with PEP at this point.
By the way Teak, the doctor gave me a blood test before prescribing the pills and checked that my liver and kidneys are performing properly at the moment - which they are. Is liver/kidney failure reduced as a risk if this test is performed beforehand? Would you recommend having this test again after a week or so to check once more? Thanks again for any advice.
Do you know how common those side effects are, and are there early warning symptoms of any kind if the effects were to become this severe? I was feeling better about the situation now that I am taking PEP but yourself and Zulu are scaring me again.
Thanks again. Hope what you mention doesn't occur of course, but like you said ... lesson learned. For the benefit of anyone who comes across this post i will update it with how I feel during the 4 weeks etc. The doctor said the 6 week test is quite conclusive so I should stop worrying after this test. It is a hard choice to give yourself such powerful drugs for potentially no reason (ie. if I have not been infected) but until an 'early detection' method is perfected it's the way things are I guess. We should be grateful that this option exists - side effects will be forgotten later, but infection would not be.
The common reactions to think about are nausea, diarrhea, malaise, rash - which are sided effects that occur commonly. These will usually not present stright away, but after a few days once drug levels have built up in your system.
Severe, idiosyncratic organ threatening reactions would usually happen a bit later - and would probably reverse after stopping the drug. Whereas a severe allergic reaction, mediated by IgE immunoglobulins - would happen after your first one or two pills.
But don't worry about this. Now that you've decided to take the drugs, accept that you may or may not feel a bit crap for the next month, and feel glad in the knowledge that although you've made a mistake, you're now giving yourself the best chance of avoiding HIV. Then collect that negative antibody test at three months after you finish the PEP, and move on.
Severe, idiosyncratic organ threatening reactions would usually happen a bit later - and would probably reverse after stopping the drug. Whereas a severe allergic reaction, mediated by IgE immunoglobulins - would happen after your first one or two pills.
But don't worry about this. Now that you've decided to take the drugs, accept that you may or may not feel a bit crap for the next month, and feel glad in the knowledge that although you've made a mistake, you're now giving yourself the best chance of avoiding HIV. Then collect that negative antibody test at three months after you finish the PEP, and move on.
reposting this directly to Zulu10: Thank you very much Zulu. Can I please ask you one very important question. If I was to have a very severe reaction to the tablets, is the reaction likely to happen early in the course or could it occur later on. At which point should I consider that my body is capable of dealing with the drugs?
Thank you very much for any information on that if you have any available.
Thank you very much for any information on that if you have any available.
Thank you very much Zulu. Can I please ask you one very important question. If I was to have a very severe reaction to the tablets, is the reaction likely to happen early in the course or could it occur later on. At which point should I consider that my body is capable of dealing with the drugs?
Thank you very much for any information on that if you have any available.
Thank you very much for any information on that if you have any available.
I just came back from the doctor. She said yes although the chance of catching it is slim she recommends taking PEP, so she has put me on Stocrin and Truvada for 4 weeks. She said the side effects may or may not be noticeable, for the benefit of anyone reading this I will post any effects that I notice, and also my result.
It was a stupid thing to have unprotected sex that way, and I know it, like everyone that has been in this situation knows.
DON'T DO IT!!! The stress is just too high, it is IN NO WAY WORTH IT! REMEMBER that even when you have been drinking.
It was a stupid thing to have unprotected sex that way, and I know it, like everyone that has been in this situation knows.
DON'T DO IT!!! The stress is just too high, it is IN NO WAY WORTH IT! REMEMBER that even when you have been drinking.
It's not a clear cut decision.
PEP is associated with significant (routine) side effects. There is also a chance of you having a catastrophic, life threatening drug reaction from PEP. And the risk of HIV transmission from a one-off episode of vaginal sex is low - even if your partner was HIV positive, which we don't know.
PEP will also delay the definitive testing point.
All that said, if she was HIV positive, PEP will reduce your risk of HIV aquisition from what it is now (very low) to as close to zero as it's possible to get.
PEP is associated with significant (routine) side effects. There is also a chance of you having a catastrophic, life threatening drug reaction from PEP. And the risk of HIV transmission from a one-off episode of vaginal sex is low - even if your partner was HIV positive, which we don't know.
PEP will also delay the definitive testing point.
All that said, if she was HIV positive, PEP will reduce your risk of HIV aquisition from what it is now (very low) to as close to zero as it's possible to get.
you should pep if you have unprotected sex and consult with your health department as soon as possible.
Have an Answer?
You are reading content posted in the HIV Prevention Community
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
Can I get HIV from surfaces, like toilet seats?
Can you get HIV from casual contact, like hugging?
Frequency of HIV testing depends on your risk.
Post-exposure prophylaxis (PEP) may help prevent HIV infection.
