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HIV RIsk after condom broken /PEP
Dear Dr,
Monday 5 october 2010 5pm I took a risk with a sex professional in germany in a sex house:
Woman is from thailand
Condom rupture at the end of the intercourse with ejaculation 15seconds unprotected sex: immediate cleaning
The professional claims to do tests and to not have any diseases, I can only believe her words and tends to believe as a professional she is not a kamikaze and always use condoms. She said she made test in September 10 and because she has a little girl she cannot take risk...
Next day,6 th october, I went to hospital, met a Aids specialist, told me yes I had a risk and I received combivir + viramune 4 days then he told me to only take combivir for the last remaining 24 days of treatment.
This day I was checked and no HIV/siphilis/hepatits detected on the 6th of october.
Everything else good, ALAT, SGPT etc.. Treatment started 16 hours later after risk. I do take a lot of vitamin B, ginseng and selenium especially before winter.
*Do i need to worry to get HIV even with the prophylaxia started before 24 hours ?
*Is the less duration to exposure (15 seconds) a good factor to avoid HIV ?
*I know there is a risk of 0.03% to 0.05% per intercourse with infected girl to get it, will prophylaxia reduce that risk ?
*I received combivir + viramune 4 days. After that period, only combivir for the last remaining 24 days, will there be same efficacity as if it was a tritherapy? I am now in the 15th day of the treatment and did not notive any upcoming other ST (clamidia etc..).
*Will Agp24 negative be a good sign ?- I have to do it next week.
*Isl absence of ARS symptoms during the first month be a good sign ?
*Based on your experience of some patients you have followed with prophylaxis, how many seroconverted and how many did not?
*Will the post treatment delay a possible seroconversion ?
Im sorry to post a bunch of questions but they are all linked to that problem and currently I feel very anxious.
Thank you very much !
Best Regards
Harvey
Monday 5 october 2010 5pm I took a risk with a sex professional in germany in a sex house:
Woman is from thailand
Condom rupture at the end of the intercourse with ejaculation 15seconds unprotected sex: immediate cleaning
The professional claims to do tests and to not have any diseases, I can only believe her words and tends to believe as a professional she is not a kamikaze and always use condoms. She said she made test in September 10 and because she has a little girl she cannot take risk...
Next day,6 th october, I went to hospital, met a Aids specialist, told me yes I had a risk and I received combivir + viramune 4 days then he told me to only take combivir for the last remaining 24 days of treatment.
This day I was checked and no HIV/siphilis/hepatits detected on the 6th of october.
Everything else good, ALAT, SGPT etc.. Treatment started 16 hours later after risk. I do take a lot of vitamin B, ginseng and selenium especially before winter.
*Do i need to worry to get HIV even with the prophylaxia started before 24 hours ?
*Is the less duration to exposure (15 seconds) a good factor to avoid HIV ?
*I know there is a risk of 0.03% to 0.05% per intercourse with infected girl to get it, will prophylaxia reduce that risk ?
*I received combivir + viramune 4 days. After that period, only combivir for the last remaining 24 days, will there be same efficacity as if it was a tritherapy? I am now in the 15th day of the treatment and did not notive any upcoming other ST (clamidia etc..).
*Will Agp24 negative be a good sign ?- I have to do it next week.
*Isl absence of ARS symptoms during the first month be a good sign ?
*Based on your experience of some patients you have followed with prophylaxis, how many seroconverted and how many did not?
*Will the post treatment delay a possible seroconversion ?
Im sorry to post a bunch of questions but they are all linked to that problem and currently I feel very anxious.
Thank you very much !
Best Regards
Harvey
MEDICAL PROFESSIONAL
Welcome to the HIV forum. Unfortunately, I cannot help with many of your questions. On this forum we advise about HIV exposures, transmission risks, interpretation of test results, and prevention. Dr. Hook and I rarely prescribe PEP and do not advise about its use. Once a person is on such treatment, the doctor or clinic who prescribed it is always be best resource for questions like yours. S/he knows more about most of your questions than I do.
The decision by your AIDS doctor to administer PEP was quite conservative; most HIV experts probably would conclude that the risk was not sufficiently high and I would not have recommended it myself. This is not critical of your doctor; there is room for differeing professional opinion about it. Most people, including sex workers, do not lie about their HIV status when asked directly -- and the information you provide suggests a very low chance your commercial partner is infected. And even if she had HIV, the chance you were infected from a single unprotected exposure was under 1 chance in 2,000 -- probably a lot lower given the very brief exposure after the condom ruptured. (Your figure of 0.03-0.05%, i.e. 1 chance in 20 to 30, is ridiculously high and just plain wrong.)
With the information you provide, I would judge the chance you caught HIV at far below 1 in a million, even without PEP. With treatment, it will be a lot lower than that. However, it will take longer than it would be without treatment to know for sure you were not infected. I do not know how long a positive p24 antigen test or antibody test might be delayed, but it could be for several weeks. All test results are good signs and a negative p24 next week will be reassuring, but not as much as if you were not treated. A positive antibody test also could be delayed beyond the usual 6 weeks. However, there has been no research to accurately predict exactly how long it might take.
In summary, I believe you risk of HIV was low enough that you didn't really even need HIV testing, except for psychological reassurance -- let alone PEP. But I see you asked the same questions on the HIV international forum. You might get more complete answers there, but this is as far as I can go on this thread. However, you can expect them to also reassure you that there was virtually no risk of HIV infection.
Good luck-- HHH, MD
The decision by your AIDS doctor to administer PEP was quite conservative; most HIV experts probably would conclude that the risk was not sufficiently high and I would not have recommended it myself. This is not critical of your doctor; there is room for differeing professional opinion about it. Most people, including sex workers, do not lie about their HIV status when asked directly -- and the information you provide suggests a very low chance your commercial partner is infected. And even if she had HIV, the chance you were infected from a single unprotected exposure was under 1 chance in 2,000 -- probably a lot lower given the very brief exposure after the condom ruptured. (Your figure of 0.03-0.05%, i.e. 1 chance in 20 to 30, is ridiculously high and just plain wrong.)
With the information you provide, I would judge the chance you caught HIV at far below 1 in a million, even without PEP. With treatment, it will be a lot lower than that. However, it will take longer than it would be without treatment to know for sure you were not infected. I do not know how long a positive p24 antigen test or antibody test might be delayed, but it could be for several weeks. All test results are good signs and a negative p24 next week will be reassuring, but not as much as if you were not treated. A positive antibody test also could be delayed beyond the usual 6 weeks. However, there has been no research to accurately predict exactly how long it might take.
In summary, I believe you risk of HIV was low enough that you didn't really even need HIV testing, except for psychological reassurance -- let alone PEP. But I see you asked the same questions on the HIV international forum. You might get more complete answers there, but this is as far as I can go on this thread. However, you can expect them to also reassure you that there was virtually no risk of HIV infection.
Good luck-- HHH, MD
Thank you Dr. Handsfield again
I will carrefuly listen to your advice that I did catch HIV and will finish my pep and then will post back my results here.
Best regards
Harvey
I will carrefuly listen to your advice that I did catch HIV and will finish my pep and then will post back my results here.
Best regards
Harvey
MEDICAL PROFESSIONAL
It is unlikely that I know more about this than your HIV specialist. I deal only with prevention and have no personal experience using PEP -- none.
It doesn't matter whether I have personally seen a case of female to male HIV transmission. Of course it can occur and in some settings is quite frequent. But based on the information you provide about your exposure, almost certainly it did not happen to you.
That's all I can say. That will have to end this thread. Take care and try to sotp worrying about it.
It doesn't matter whether I have personally seen a case of female to male HIV transmission. Of course it can occur and in some settings is quite frequent. But based on the information you provide about your exposure, almost certainly it did not happen to you.
That's all I can say. That will have to end this thread. Take care and try to sotp worrying about it.
Dear Dr. Handsfield,
thank you very much for those accurate details. I can only tell you one thing: if only I had a doctor like you around...
Because today I went back to my hiv specialist, I asked him what are my odds he replied:
you have a risk of less 1% probably 0.5% and maybe a bit less with the PEP. How can such a specialist not being aware of reliable numbers we can easily find everywhere or is it a plan to scare people?
He told me also during first month of PEP it is useless to test vih, i asked for PCR he said that does not make sense during PEP. He recommended me to wait 1 month after the 28 days of PEP to get a reliable test. Does that make sense? Can we not be sure just after first month?
Aside this I dont experience any side effects, my blood is checked every 15 days for liver modification.
Hopefully he did tell me he has not seen any seroconversion occured after PEP so far which I take as a good sign.
I can only follow your advice of a negligeable risk? You are a reliable expert and probably more than my HIV specialist.
I wanted to ask you as I read it somewhere in the forum: is that ture you have never seen female to male contamination? Not sure I read that statement correctly.
Kind regards
Harvey
thank you very much for those accurate details. I can only tell you one thing: if only I had a doctor like you around...
Because today I went back to my hiv specialist, I asked him what are my odds he replied:
you have a risk of less 1% probably 0.5% and maybe a bit less with the PEP. How can such a specialist not being aware of reliable numbers we can easily find everywhere or is it a plan to scare people?
He told me also during first month of PEP it is useless to test vih, i asked for PCR he said that does not make sense during PEP. He recommended me to wait 1 month after the 28 days of PEP to get a reliable test. Does that make sense? Can we not be sure just after first month?
Aside this I dont experience any side effects, my blood is checked every 15 days for liver modification.
Hopefully he did tell me he has not seen any seroconversion occured after PEP so far which I take as a good sign.
I can only follow your advice of a negligeable risk? You are a reliable expert and probably more than my HIV specialist.
I wanted to ask you as I read it somewhere in the forum: is that ture you have never seen female to male contamination? Not sure I read that statement correctly.
Kind regards
Harvey
MEDICAL PROFESSIONAL
Your document states 0.05%, not 0.05. 0.05% = 0.0005.
seems in France they re afraid of any risk :)
1/2000= 0.0005
my documents stated 0.05
both are low i agree
anyways you recommand me to not worry at all and this is a good advice
1/2000= 0.0005
my documents stated 0.05
both are low i agree
anyways you recommand me to not worry at all and this is a good advice
MEDICAL PROFESSIONAL
I have no French, but the table in that reference is directly from CDC's figures for the US. The data aren't very precise, but the French article has adoped the same figures. When you wrote 0.03% and 0.05%, I thought you meant 3% and 5% (0.03, 0.05). 0.05% is the same as 1 in 2,000. This was my mistake; I apologize for any confusion.
The bottom line is that you were at exceedingly low risk for HIV; and while I do not wish to criticize an entire nation's policy on HIV prevention, I disagree with use of PEP in such a low risk situation. The chance of serious side effects from PEP treatment probably is higher than the chance you caught HIV. But that's an issue for you to discuss with your doctor, not for me to resolve.
Good luck-- HHH, MD
The bottom line is that you were at exceedingly low risk for HIV; and while I do not wish to criticize an entire nation's policy on HIV prevention, I disagree with use of PEP in such a low risk situation. The chance of serious side effects from PEP treatment probably is higher than the chance you caught HIV. But that's an issue for you to discuss with your doctor, not for me to resolve.
Good luck-- HHH, MD
Dear Dr Handsfield,
thank you for your valuable inputs. I agree to your comments. I was myself quite suprised to see I received PEP as I did not force the Aids Expert in hospital. But in France, as Im here right now, they have instruction to give it to anyone who was exposed to a risk even the smallest one, except for oral risks...
I agree when you say sex workers normally not lie about HIV statuts but there is also room for her to not know her status clearly or to got infected just before me.
I agree when you say my exposure was low, but why do they told me in hospital, time exposure does not matter? to affraid me?
Your figure of 1 chance in 2000 sounds a bit curious to me as all documents I consulted in Europe showed 0.03% to 0.05%. The Swiss documentation shows 0.05% as per at http://revue.medhyg.ch/print.php3?sid=33111
relation vaginale homme= vaginal penetration
Are your numbers US ones?
Again thank you very much for reassuring me ! I clearly understand based on the elements I gave you that my risk is probably below than the chance to win lottery 2 times or even 3 times..
But as you may know patient always seek information to address unrational fears, especialy on this disease that is still very complex to understand.
Best
Harvey
thank you for your valuable inputs. I agree to your comments. I was myself quite suprised to see I received PEP as I did not force the Aids Expert in hospital. But in France, as Im here right now, they have instruction to give it to anyone who was exposed to a risk even the smallest one, except for oral risks...
I agree when you say sex workers normally not lie about HIV statuts but there is also room for her to not know her status clearly or to got infected just before me.
I agree when you say my exposure was low, but why do they told me in hospital, time exposure does not matter? to affraid me?
Your figure of 1 chance in 2000 sounds a bit curious to me as all documents I consulted in Europe showed 0.03% to 0.05%. The Swiss documentation shows 0.05% as per at http://revue.medhyg.ch/print.php3?sid=33111
relation vaginale homme= vaginal penetration
Are your numbers US ones?
Again thank you very much for reassuring me ! I clearly understand based on the elements I gave you that my risk is probably below than the chance to win lottery 2 times or even 3 times..
But as you may know patient always seek information to address unrational fears, especialy on this disease that is still very complex to understand.
Best
Harvey
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