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I had sex with HIV positive Undetectable person; I am HIV negative and on PREP, What is my risk?

Question: 

Hello,
I have a bit of anxiety and really need to know what my odds are. I have been doing everything in my life to ensure I maintain my status negative so here are the details

I started prep on the 18th of March 2019 and I had sex with someone that was HIV positive undetectable on the 30th of March 2019. I know he is Undetectable because he was kind enough to take the effort in showing me his most recent results that were on 19th Of march 2019 he showed me the medication he takes and he confessed to me that he had been positive for 6 years and that he has mainted a viral load less than 20 copies. I am also on prep and have taken it the same time every day up to this point I even took an extra one after I found all this out. Yesterday. I was the top and sex wasn't out of the Norm and I am certain of his undetectable status and saw the medication that he takes. He even sent me a copy of those results from the lab. What is my level of risk? If someone whom is hiv positive undetectable with a viral load of less than 20 copies, has unprotected anal sex with someone who is HIV negative and has been taking prep for 2 weeks?

Please help me ease my anxiety, I refrained from treating him badly because he is a kind person and plus he looks really healthy! not only did he show me the proof but it is evident from how he looks! I would defiantly consider taking things farther with him but I need the facts and the education of what my risk will be even under these; what I consider, to be optimal circumstances. where he and I have open communication and he is being forthcoming and honest.

Do these factors put me at risk for getting HIV?

Thank you

Answer: 

Hello,

Thank you for your inquiry. From what we gather from the question, you were asking about the HIV transmission risk associated with engaging in unprotected anal sex with someone who is HIV positive with an undetectable viral load. From the information given, this scenario is determined to be High Risk (Evidence of transmission through these activities and is the majority of cases of transmission) solely due to the activity (unprotected sex), and not the partner.

The scenario mentioned above does meet the three components of the Transmission Equation. I commend you for seeking out PrEP before engaging in risky activities and for ensuring open and honest communication between you and your partner. The following excerpt is from a question I answered previously in regards to the risk associated with having sex with an HIV positive person who has an undetectable viral load when you are HIV negative (i.e. serodiscordant couple):

"The best resource for information about sex among serodiscordant couples is the PARTNER study (1). This study followed almost 900 serodiscordant couples, in which the HIV positive partner was taking effective HIV treatment. The researchers found that these couples had a total of 58,000 unprotected sexual encounters with their partner within the time frame of the study and there was ZERO transmission of HIV among partners. This enforces the point that a person living with HIV who has an undetectable viral load is not able to transmit the virus through sexual intercourse, and thus when HIV is undetectable it is untransmittable (2)."

Daily PrEP can reduce your risk of acquiring HIV through sexual intercourse by greater than 90% (3). It is important to note that taking an extra pill will not make the medication more effective and is not recommended as the PrEP dosage provided to you is optimized to prevent HIV transmission. With this information in mind, and the many tools at your disposal such as continuing PrEP and condoms (which would further decrease your HIV risk by ~80% (4)), there is no reason to stop engaging in sexual activity with this man because of his HIV status. If you do decide to continue seeing him as a serodiscordant couple, it is recommended to access HIV testing at least once a year (5).

Recommendation: Refer to a physician for an HIV test and for more personalized answers.

Regards,

AIDS Vancouver Helpline/Online, Marie