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Risk of transmission and other questions

Question: 

Hello ,
I am Rodrigo. I write you because I have inquiries about risks of transmission of HIV, and also other questions. By October 31th, 2011, I had receptive and protected anal sex ( we used condom which did not break) with a guy whom has HIV (I realized of that the next morning of the intercourse). Also, I did fellatio to him (without condom), but there were not ejaculation, and when we were kissing ( eating a chocolate), I accidentaly bit his lip so I guess there was some infected blood that came into my mouth. I did not have any cut in my oral mucosa, but I was receiving treatment for peptic ulcers because of Helicobacter Pylori infection. He was diagnosed by June 20th, 2011 ( when his viral load was 76,500 copies/ml). Since that time, he is receiving HAART with lamivudine-zidovudine-Nevirapine twice daily, but he told me that there are some days ( at maximun 3) that he does not take the pills.
When I realized of him diagnosis, I went to a doctor who gave me profilaxis about 18 hours post-exposure with lamivudine-zidovudine, at 24 hours I received Efavirenz, and at 36 hours I received Lopinavir-Ritonavir. My question is : What is my overall risk of acquiring HIV, taking in consideration all that I have described above?.
I got an EIA 4th Generation at 33 days post-exposure, and 63 days post exposure ( 33 days post-PEP), both came back negative. How accurate are my results?. Do I need more testing?. I am planning to get another test within 1 month, What is the likelihood that my results would change?.
Thank you very much in advance.
Sincerely,
Rodrigo.

Answer: 

Hello Rodrigo and Thank You for using the AIDS Vancouver Helpline as your source of AIDS related Information.
I will try to quantify your overall risk of exposure given the activities you described.
1) Protected receptive anal sex, and giving oral sex without a condom, are both considered low risk exposures, because they don’t involve exchange of HIV + bodily fluids. There have only been a few reports of infection attributed to this activity.
2) Taking blood into the mouth is also considered a low risk exposure, even if you were receiving treatment for peptic ulcers. Additionally, saliva contains an enzyme that inhibits the HIV virus.
3) Taking PEP (Post-Exposure Prophylaxis) as prescribed by your doctor functions to decrease your chance of contracting HIV even more. PEP has shown to decrease infection rate by more than 80%, if taken for a full 28 days.
Your negative test results can be considered accurate, and it is unlikely the will change after a month. However, for completely conclusive and definitive results international guidelines recommend re-testing at 12 weeks (3 months) post-PEP.
Please also keep in mind that being exposed to HIV does not mean you will be infected with HIV—not all exposures result in infection & the fact that your partner was taking HAART further reduces the likelihood of transmission. So, it is great to hear that you are getting tested. Your results are good indicators of your status but re-testing again at 12 weeks will be much more accurate.
Take Care,
Elyse
AIDS Vancouver Helpline Volunteer
e: helpline@aidsvancouver.org
p: (Mon-Fri 9-4pm ): (604) 696-4666
w: www.aidsvancouver.org/helpline