PEP: Post-Exposure Prophylaxis for HIV Prevention - Internal Medicine

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Post-Exposure Prophylaxis (PEP) is a critical intervention for individuals who may have been exposed to HIV, particularly through high-risk behaviors such as unprotected sex. Your situation raises several important points regarding the effectiveness of PEP, the risk of HIV infection, and the timing of follow-up testing.

1. Effectiveness of PEP: You are correct that initiating PEP within 72 hours of potential HIV exposure can significantly reduce the risk of infection. Studies have shown that when taken as directed, PEP can lower the risk of HIV transmission by more than 90%. The key is to start the medication as soon as possible after the exposure, which you did by seeking treatment within approximately 9 hours. The sooner PEP is started, the more effective it is in preventing HIV from establishing an infection.

2. Risk of Infection: The risk of HIV transmission from a single exposure can vary based on several factors, including the HIV status of the partner, the type of sexual activity, and whether any protective measures were used. In your case, since you used a condom during part of the encounter, this reduces the risk, but the unprotected intercourse does pose a risk. However, since you have started PEP promptly, the likelihood of contracting HIV is significantly reduced. It's important to remember that while PEP is highly effective, it is not 100% guaranteed to prevent infection.

3. Testing for HIV: Regarding your question about testing, it is advisable to get tested for HIV after completing the PEP regimen. The timing of the tests is crucial. While you may be tempted to test sooner, it is recommended to wait at least 4 to 6 weeks after completing PEP for an accurate result. This is because PEP can suppress the virus, potentially leading to false-negative results if testing is done too early. The rT-PCR test, which detects the viral load, can be done during the PEP treatment, but it is generally more informative to rely on antibody tests (like the fourth-generation antigen/antibody test) after the PEP course is completed.

In summary, you have taken the right steps by seeking PEP treatment promptly after potential exposure. The risk of HIV infection is significantly reduced due to your timely intervention. For follow-up, plan to have an HIV test 4 to 6 weeks after completing the PEP regimen to ensure accurate results. If you have any ongoing concerns or symptoms, it is always best to consult with your healthcare provider for personalized advice and further testing if necessary.