How protected am I?

[JamieL95]

I finally decided I wanted to take the risky leap and hookup with poz guys, so I went on Prep starting a few days ago. I took 2 pills on day 1, then 1 pill on day 2. I forgot to take the pill on day 3, and then I took 2 pills on day 4. Today is day 5 and I took 1 pill, but then this evening, I chatted up a toxic top who had been on a meds holiday for 6 months. I was too horny, so we met up and I let him breed me and kept the cum inside. Feeling a bit of regret now.

Am I protected enough if I just keep taking Prep daily for the next month? Or do I need to go to the clinic first thing in the morning to get PEP? Everything is closed right now and I don’t want to pay ER visit costs just to get PEP a few hours earlier….

Any advice?

[BootmanLA]

It's a gamble, and while the odds "favor" you not being infected, there are certainly no guarantees, you could well be infected.  It's a little late for this response (I was away for a day or two, so couldn't answer), but if you'd gone the following day (Wednesday in the morning and gotten PEP - and taken it religiously for the next 30 days -  you'd almost certainly be okay. And I hope that's what you did.

(Alternatively: if you'd taken two PrEP tablets at least 2 hours before he fucked you, and then one more each day for the next two days 24 hours after the sex, you would have also been OK. But you didn't have that double dose in your system BEFORE the sex, which is critical - it's got to be there at the point when HIV tries to enter your system to start with.)

But PrEP only contains two active ingredients. In sufficient levels in your system - which takes several days to reach from when you start, unless you do the "on demand" dosing properly - it can prevent an HIV infection (and almost always will). That said, you weren't taking the on-demand dosing approach, and you hadn't been taking it long enough on the "daily" dosing regimen to have reached complete protection, either. So you weren't fully protected.

And if HIV enters your system while you're not fully protected, it doesn't always result in an infection, but it CAN. And if it does, PrEP alone isn't enough to eradicate HIV when used "after the fact"; PEP includes additional active ingredients that can help keep that HIV from establishing a beachhead, so to speak.

PEP is generally effective if taken within 24 hours of sex. It can be effective if taken up to 48 hours after sex, but the efficacy of the treatment declines the longer you go without.

I hope you did, in fact, get PEP at the clinic on day 6, and are sticking with it.

If not, then (a) it's too late, really, and (b) I am going to give you a controversial recommendation that may be painful short-term, but is your best bet for long-term health.

1. Stop having sex, period, for at least a month, preferably for more like 45 days. (This step is critical for the rest of this advice, If you can't do that, then the rest is pointless).

2. Don't restart PrEP. At this point, if you're not actually having sex (see #1), it's not needed, And if you are infected already, PrEP won't cure it, and in fact can lead to the HIV you have becoming resistant to the two ingredients in PrEP (which are commonly part of other HIV treatments, which might make those treatments useless for you too).

3. Get a rapid HIV test in about a week, and then again every few weeks, until the 45 days are up. If any show up positive, get to a clinic where a more definitive test can be done. Rapid tests are not necessarily 100% accurate, so you might have a false positive, or you might have been infected but continue to test negative on the rapid test.

4. If you do test positive and it's confirmed, get on treatment ASAP.

5. If you test negative at the end of the 45 days, you are almost certainly in the clear. At that point, go get a definitive test from a clinic or lab, and assuming it confirms you're negative, then re-start PrEP, and this time, remember how much of a pain in the ass all this was, and stick to the regimen. That means waiting at least one more week after you start taking it again before your next sex, with no missed doses.

[RubberAustria]

Hi! I would not worry. There are studies that say 3 pills a week give you a protection of 70% ! You do the „on demand regime“. I did that for several years. Nothing happened. So you did 2 pills within a few days, that is good. Next time stick to 2-1-1-1 etc. to get your loads without regrets or fear.

Have fun

[BootmanLA]

3 hours ago, RubberAustria said:

Hi! I would not worry. There are studies that say 3 pills a week give you a protection of 70% ! You do the „on demand regime“. I did that for several years. Nothing happened. So you did 2 pills within a few days, that is good. Next time stick to 2-1-1-1 etc. to get your loads without regrets or fear.

Have fun

The point is that he did NOT do the 2-1-1 regime for "on demand" use.

That calls for 2 pills anywhere from 2 to 24 hours before sex, followed by additional pills 24 and 48 hours after the sex. It works presumably because the level of medication in the person's system is double what it would normally be at the time of potential infection, and the two additional days afterward maintain a high level until the chances of HIV taking hold end.

He took 2 tablets more than 24 hours in advance of sex, meaning that the amount in his system was less than the minimum required for effective on-demand dosing.

And because he'd only been on the medication for five days - with a missed day among those, although there was also a double-dose day - his system hadn't achieved the "baseline" level of medication provided by daily dosing, either. He didn't have zero protection, granted. But based on what he described, with the number of doses he took so far, he was probably about 75% protected.

Assuming the top was, in the OP's words, "toxic" and on a "med holiday" for six months, that's certainly potentially sufficient to infect someone, even one with that level of protection. If the strain the top had was PrEP-resistant, that makes it even more possible.

On the flip side, even a bottom not on PrEP who takes a load from an HIV positive top who is detectable is not guaranteed to get infected.

Even more importantly, the OP was looking for guidance as to his proper course of action RIGHT NOW, when he's not sure if he might have been infected or not. Telling him "not to worry" and to just go on taking PrEP 2-1-1 before sex in the future is downright irresponsible. If he IS infected - and he won't know for a few weeks when the testing would be able to detect it - then continuing to take PrEP, which won't eradicate the virus already in him, may result in a strain that is resistant to some of the drugs needed to treat it.

I'm hoping that he actually got PEP the day after his sexual encounter, which would have a much greater chance of protecting him than assuming he is okay and just going back to taking PrEP. But if he did not get PEP within the suggested timeframe, and he really does want to remain HIV-negative, your approach is risky at best.