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Bangkok Potential Exposure
I guess the doctor's forum for HIV Prevent is not accepting new questions so will post here.
I had a condom failure with a Female CSW in Bangkok about 72 hours ago. I withdrew immediately upon sensing the break (less than one minute). CSW assured me negative HIV checks in April and June.
24 hours post the incident, the CSW agreed to go with me to Bumrungard Hospital in BKK. I paid for us both to be evaluated and tested. The doctor administered HIV ag/ab combo tests for both of us and administered PCR RNA test for the CSW. He prescribed PEP for me. I began PEP at 26 hours post exposure.
Within a few hours Ag/Ab tests for both of us came back negative. We will receive the PCR results today for her.
Question for the forum is - I believe in the vast majority of health care settings I would not have been offered PEP (even within Bangkok, this particular hospital caters to affluent medical tourists)
If her PCR comes back negative. That essentially indicates 99% like probability she was not positive as of 10-14 days ago (combo of the Ab/Ag and PCR). Does this mean discontinuing PEP makes sense? I would rather get to a 28-day definitive duo test than having to wait longer post full PEP treatment given the real mish-mash of guidelines on testing post PEP (CDC vs. European vs. Thai)
As for other STDs, 2g Azithromycin, 250g IM Rocephin, and Dox 2x100mg x 14 days were given as prophylaxis for bacterial infections (Chlaymydia, Gonn, NGU, Syph) - prob overkill but I'm travelling.
I had a condom failure with a Female CSW in Bangkok about 72 hours ago. I withdrew immediately upon sensing the break (less than one minute). CSW assured me negative HIV checks in April and June.
24 hours post the incident, the CSW agreed to go with me to Bumrungard Hospital in BKK. I paid for us both to be evaluated and tested. The doctor administered HIV ag/ab combo tests for both of us and administered PCR RNA test for the CSW. He prescribed PEP for me. I began PEP at 26 hours post exposure.
Within a few hours Ag/Ab tests for both of us came back negative. We will receive the PCR results today for her.
Question for the forum is - I believe in the vast majority of health care settings I would not have been offered PEP (even within Bangkok, this particular hospital caters to affluent medical tourists)
If her PCR comes back negative. That essentially indicates 99% like probability she was not positive as of 10-14 days ago (combo of the Ab/Ag and PCR). Does this mean discontinuing PEP makes sense? I would rather get to a 28-day definitive duo test than having to wait longer post full PEP treatment given the real mish-mash of guidelines on testing post PEP (CDC vs. European vs. Thai)
As for other STDs, 2g Azithromycin, 250g IM Rocephin, and Dox 2x100mg x 14 days were given as prophylaxis for bacterial infections (Chlaymydia, Gonn, NGU, Syph) - prob overkill but I'm travelling.
Yes, but that particular hospital caters to affluent medical tourists, so I am concerned they really deal with and try to address .000000001% scenarios, not to mention sell very expensive PEP drugs at a heafty margin . . .
Yes, it seems you are pretty informed. If you have the chance to talk with the dr that prescribed PEP, he will guide you better.
I was hoping for more input, but I know people are busy.
As an update. The CSW's qualitative PCR came back negative yesterday, which makes it unlikely she did not have HIV unless she acquired it 12-36 hours immediately leading up to our encounter and really improbably (around 99%) given PCR accuracy she was negative as of about 7-days prior to our encounter.
I think that would indicate it is safe to discontinue PEP so that I can get to definitive testing a lot faster and put the incident behind me.
I talked to a few ID specialists agreed, but was wondering if anyone here has any input . . . .
As an update. The CSW's qualitative PCR came back negative yesterday, which makes it unlikely she did not have HIV unless she acquired it 12-36 hours immediately leading up to our encounter and really improbably (around 99%) given PCR accuracy she was negative as of about 7-days prior to our encounter.
I think that would indicate it is safe to discontinue PEP so that I can get to definitive testing a lot faster and put the incident behind me.
I talked to a few ID specialists agreed, but was wondering if anyone here has any input . . . .
Well, I'm quite certain PCR testing is not recognized as definitive by any health authority (it needs antibody testing for confirmation). That being said, my understanding is that in clinical settings (especially outside the USA) 7-10 days negative PCR tests are viewed as "quasi-definitive" for clinical purposes (i.e., if the exposure was deemed lower risk initially, then neg PCR at 7-10 days is highly indicative but not confirmatory)
Nonetheless, my main issue here is that CSW was kind enough to go through with the testing for me, and should her PCR be negative and I already know her Ag/Ab is negative, that should really reduce her risk for having HIV down to the "blind" testing window which would be about 10 days in this case.
So in my mind, I am taking PEP in the unlikely chance the CSW contracted HIV during the past 10 days. For reference venued-CSW HIV incidence in Thailand is 2.5% based on most conservative data. So my imputed probability (conservatively) of infection is 1/1000 * 1/25 = 1/25000 (I would think her negative testing dramatically reduces my risk as well)
So I'm wondering if going through with PEP is worth it (assuming PCR turns out negative), given I could have peace of mind 15-28 days from now if I discontinued PEP and had a PCR or DUO vs. having to wait 4 months or so i follow through with PEP (as current reco's on PEP testing are 3 months post completion of PEP)
Hope that makes sense . . .
Nonetheless, my main issue here is that CSW was kind enough to go through with the testing for me, and should her PCR be negative and I already know her Ag/Ab is negative, that should really reduce her risk for having HIV down to the "blind" testing window which would be about 10 days in this case.
So in my mind, I am taking PEP in the unlikely chance the CSW contracted HIV during the past 10 days. For reference venued-CSW HIV incidence in Thailand is 2.5% based on most conservative data. So my imputed probability (conservatively) of infection is 1/1000 * 1/25 = 1/25000 (I would think her negative testing dramatically reduces my risk as well)
So I'm wondering if going through with PEP is worth it (assuming PCR turns out negative), given I could have peace of mind 15-28 days from now if I discontinued PEP and had a PCR or DUO vs. having to wait 4 months or so i follow through with PEP (as current reco's on PEP testing are 3 months post completion of PEP)
Hope that makes sense . . .
PCR is definitive. It is more specific and sensitive because it looks for the presence of viral RNA (genetic material). If you still want to be more sure you can have an ultrasensitive HIV PCR. But based on what you had so far you are not at risk of HIV. I can not tell you if you should or not stop your PEP, that is only a professional decision that need to be made by a Doctor.
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