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PEP started at 55+ hours, anxious as hell

Merry Christmas! Mine did not start out so well. I'm a 33 year old male and had sex, using a condom, with a bar girl (i.e., a sex worker) in Bangkok, Thailand. At some point during the act the tip of the condom was ripped and there could have been at least a few minutes quite exposed action before I noticed the matter. The girl told me that she was tested negative for HIV 1 month ago, but of course that still leaves a window for infection. She will be tested again in five days and has promised to tell me about the result.

I regret that I only read about PEP nearly 40 hours after the event. But I rushed to the Bangkok Thai Red Cross AIDS Clinic, hoping to still make it quite safely even under 48h. But they insisted on testing for HIV before giving PEP medication and the clinic was closing, so they told me to come back tomorrow, which was this morning (I tested negative for HIV, which was to be expected). I'm quite surprised about this, having read about how important it is to start PEP early. But nothing can be done about that now. Anyway, at 55+ hours I finally got the meds and started a 28-day RPV/FTC/TDF treatment, which they apparently use at that clinic. They seemed quite unconcerned about the 55h, since it was still under the 72h limit, but I see that some countries recommend not more than 48h, or even the NY State 36h PEP limit. Hence, I worry.

Apologies for the long story, but posting it here is a way for me to deal with the anxiety that the situation has caused. I realize that the risk must be quite low, even more so if my partner still tests negative in five days time. But since I'm on the PEP meds, I'd like to hear any opinions about the RPV/FTC/TDF regime, which I haven't found so much data on. I know the Rilpivirine (RPV) has to be taken with full meals, which will cause some hassle due to the fact that I'll be changing time zones several times during the 28 days. But how about effectiveness and side effects? Should I get my liver values monitored? I can do so about a week or two weeks in, but not really after that due to planned travelling.

I'm considering of using Imovane (Zopiclone) to help me sleep through the anxiety (I hardly slept at all last night) and I also take a Deva One Daily multivitamin & mineral pill. It looks as if both of these should be safe with these PEP meds? I'm also hoping to be able to keep exercising regularly.

Finally, the Thai doctor who prescribed the PEP meds told me to get tested for HIV right after finishing the 28-day treatment (so would that be on the 29th day?). I'll be travelling and will be in San Francisco then, so would need to get tested there. If tested positive, the doctor told me that I should continue the medication (so I'd need to get more, as I have only enough for the 28 days). Any recommendations as to where to do the test (reliable & with quick turnaround) in San Francisco? I see that some of the (free) tests are only available for gay/bi men, which I'm not. But I need to get tested on a specific day as I'm moving on again right away. I'd be happy to pay for a test if needed. The doctor recommended a second test three months from exposure (rather than from finishing PEP) -- apparently he thinks that seroconversion is not significantly delayed by PEP, but I'd like a second opinion on this.

Thanks for reading and for any advice you can give!
1 Responses
Avatar universal
An antibody test 3 months AFTER YOUR LAST PEP DOSE would be conclusive. Some would recommend a DUO test at 28 days "after finishing PEP".  
The odds are very much in your favor, however, do get tested at the appropriate time. Hopefully, others will confirm my answer.
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