PEP: Effectiveness, Testing, and Oral Exposure Risks - Internal Medicine

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Understanding Post-Exposure Prophylaxis (PEP) is crucial for anyone who may have been exposed to HIV. PEP is a preventive treatment that involves taking antiretroviral medications after potential exposure to HIV to reduce the risk of infection. Here, I will address your questions regarding the effectiveness of PEP, testing accuracy, and the risks associated with oral exposure.

1. Effectiveness of PEP: You mentioned that you took PEP (Biktarvy) within 72 hours of potential exposure and completed the full 28-day regimen. The effectiveness of PEP is indeed high when taken correctly; studies suggest that it can reduce the risk of HIV infection by more than 90% when initiated promptly after exposure. The slight delay in taking the medication (up to 30 minutes late on a few occasions) should not significantly impact its effectiveness, as most guidelines indicate that a one-hour window does not compromise the treatment.

2. Testing Accuracy: Your HIV Ag/Ab Combo test on December 5 was negative, which is a positive sign. The accuracy of this test is generally high, especially when performed at least 4 weeks after potential exposure. Since you were on PEP, it is important to note that while PEP does not typically affect the results of the HIV test, it is recommended to wait for a conclusive result after completing the regimen. The negative result you received is indeed trustworthy, especially if you have not engaged in any further high-risk behaviors since starting PEP.

3. Future Testing: Regarding your follow-up test in March, if that test also returns negative, it would provide a strong indication that you have not contracted HIV. However, it is essential to understand that while the risk is significantly reduced, no test can guarantee 100% certainty. The recommended follow-up period after completing PEP is typically 3 months to ensure that any potential infection is detected.

4. Success Rate of PEP: The success rate of PEP is indeed reported to be over 90% when taken as prescribed. Adherence to the medication schedule is critical for maximizing its effectiveness. Since you have completed the full course and have tested negative, you have significantly lowered your risk of HIV infection.

5. Risk Assessment of Oral Exposure: The risk of HIV transmission through oral sex is generally considered to be low, especially in the absence of ejaculation in the mouth or the presence of cuts or sores in the mouth. In your case, since you engaged in brief oral sex without ejaculation and rinsed your mouth afterward, the risk remains low. However, it is not zero, particularly if there are open wounds or bleeding gums involved, as these can increase susceptibility to infection.

In summary, your proactive approach to seeking PEP and subsequent testing is commendable. Continue to follow up with your healthcare provider for any additional testing and guidance. It is also advisable to maintain open communication with sexual partners about HIV status and safe practices to further reduce risk. Remember, regular testing and safe sex practices are key components of sexual health.