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Should I do the PEP or not?

Question: 

Hello everyone,

Thank you in advance for your support. This morning I had sex with a girl I've been dating for 2 weeks and the condom broke. She did an HIV test on Apr 20 resulting negative.

I already went to the hospital and consulted a doctor which first suggested to do the PEP (the girl had many partners before) and then recommended to just get her to test today. The doctor said if she's negative today there's no need for me to do the PEP as with 2 negative tests in a month the risk of being infected would be very very low (0.001%) even in the case she had sex with other partners while she was dating with me.

I got tested today and I'm HIV negative and I'm taking her to test in 3 hours. If she's negative I won't take the PEP pills. If she's positive I will. What do you guys think about this?

Thank you!

Answer: 

Hello,

Thank you for your inquiry. From what we gather from the question, you were asking about your risk of HIV acquisition after a condom broke during intercourse and whether or not you should take PEP. 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).

When assessing risk of HIV transmission it is important to note that we focus on the activity, and not the persons engaging in said activity. It would be of no value to HIV risk assessment to speculate on a person's HIV status, or the number of sexual partners they have had. Focusing on the activity gives us the most useful information when assessing the risk of HIV transmission.

The scenario mentioned above does meet the three components of the transmission equation(1), resulting in a High Risk assessment. From what we gather you engaged in penetrative intercourse and the condom broke. This results in us classifying the activity as unprotected intercourse, which is considered a High Risk activity. An HIV test is the responsible thing to do in this scenario and we are glad to hear that both you and your partner have since been tested resulting in a negative result for the both of you.

PEP (post-exposure prophylaxis) means taking antiretroviral medicines (ART) after being potentially exposed to HIV to prevent becoming infected. PEP should be used only in emergency situations and must be started within 72 hours after a recent possible exposure to HIV(2).

We can see from above that PEP is recommended after a High Risk risk exposure. Why? As you can see from above, PEP is time sensitive, meaning that it must be started within 72 hours after a recent possible exposure to HIV. You state that your partner tested negative on April 20th. If this is the case, your physician consult has provided you with the correct information. We would encourage your partner to receive confirmative HIV screening within your 72 hour window period, in case you require PEP. We would like to highlight again that both you and your partner have already tested negative. You have been tested for a second time with another negative result and your partner is being tested again today. We do not know what type of HIV test you had, but we can tell you that HIV tests are highly reliable(3) and are a great indicator of your HIV status.

Recommendation: Confirmative HIV testing for your partner. PEP if required. Refer to your Physician for further health related concerns and testing results.

Regards, AIDS Vancouver Helpline/Online, Hilary