Are there possibilities of disease transmission if I had penile bleeding during unprotected sex with a sex worker having 51 copies of HIV in RNA PCR test?

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Let me know if you were wearing a condom during vaginal sex because HIV (human immunodeficiency virus) transmission is possible if you do not use a condom during vaginal sex. There is no or little risk of HIV transmission through oral sex. Sexual activities that do not involve contact with body fluids (semen, vaginal fluid, or blood) carry no risk of HIV transmission.

1. The sex worker may have had an HIV infection but a low viral load. But if oral sex was the only way of exposure, it is doubtful that the disease would get transmitted to you.
2. A 51 copies/ml viral load comes within the range of an undetectable viral load of 40 to 75 copies/ml. This could be caused by ongoing anti-HIV therapy. However, this could also be the result of an old HIV infection. At this viral load considering other tests negative, she may be less likely to transmit to you even if you have been exposed vaginally (without condoms).
3. Elevated liver enzymes called AST (aspartate transaminase) and ALT (alanine transaminase) are common in HIV-infected patients taking antiretroviral medications and can indicate liver damage. However, it can also be caused by hepatitis B or C transmitted coinfection. Therefore, I suggest you get tested for these diseases as well.
4. Do not stop the post-exposure prophylaxis medicine before getting these lab reports. However, consult the physician, discuss with them and start taking medications with their consent.

Thank you and take care.

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

I have seen the reports (attachments removed to protect the patient's identity).

1. There would be every likelihood of transmission of HIV infection to you if she was infected. But the chance of transmission is low or negligible since she has a viral load in the undetectable range and if she is already on post-exposure prophylaxis.
2. Viral load directly measures HIV RNA (ribonucleic acid) levels, whereas other tests are indirect. However, the clinical scenario is more likely to have a positive antibody test but an undetectable HIV-1 RNA level in case of HIV infection. Hence, HIV antibody tests are employed for screening purposes, and positive HIV RNA levels are considered.
3. Lack of antibody response to HIV-1 is rare due to a defect in HIV-1-specific immunity rather than infection with the attenuated virus. Since she has negative antibody tests and a nearly undetectable HIV-1 RNA level, it is possible that she also does not have HIV infection. It is also likely that she has been constantly on anti-HIV medications.
4. You did the right thing in starting PEP (post-exposure prophylaxis) within 72 hours. The optimal duration for PEP is around four weeks. It is recommended to periodically screen antibody-antigen and NAT (nucleic acid testing) or if you develop signs and symptoms suggestive of HIV even after completion of PEP.
5. Both HIV infection and anti-HIV drugs can cause raised liver function parameters. However, your laboratory tests do not currently warrant stoppage or dose reduction unless you have signs and symptoms of jaundice, increased indirect bilirubin, and other LFT (liver function test) parameters, and since the duration of therapy is about four weeks.
6. However, to rule out the other possible concomitant causes of raised liver function test elevation, I suggest you undertake blood tests for hepatitis B and C.
7. In general, oral sex is known to have less than a 0.1 % chance of sexual transmission of HIV. The possibility of transmission to you due to oral sex is relatively low, considering the issues mentioned above.

I hope this helps.

Thank you and take care.

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

1. PEP (post-exposure prophylaxis) medicines do cause adverse events. There is a low risk of gastrointestinal adverse effects with Tenofovir plus Lamivudine, such as nausea, abdominal bloating, and vomiting, along with headaches. Low risk of neuropsychiatric effects with Dolutegravir may also exist. The most frequent first adverse events are gastrointestinal disorders (22 %), followed by general symptoms (9 %), hypersensitivity reactions (1.6 %), and CNS (central nervous system) symptoms (1.3 %).

Lopinavir or Ritonavir has greater potential for drug-drug interactions and adverse effects than other medicines such as Raltegravir, Dolutegravir, and Darunavir- Ritonavir with little added efficacy benefit expected.

Hence it depends on which drugs are being administered to you, the adverse events may slightly differ. Muscular pain and joint pains are rare adverse events but do happen.

2. Fourth generation HIV (human immunodeficiency virus) test negativity shows the likely efficacy of PEP therapy. However, it is ideal to check continued viral negativity with a test, after 3 months of the last dose of PEP.

3. Muscle and joint pain may happen due to multiple other causes such as stress and is lesser likely with PEP therapy.

I hope this helps.

Thank you.

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

As stated earlier, it is ideal to check continued viral negativity with a test, after 3 months of the last dose of PEP (post-exposure prophylaxis). It would be preferable to check up with a rheumatologist for joint pain-related issues. The symptoms are quite generic and not related to HIV (human immunodeficiency virus) specifically, also there is negative clinical evidence to deduce the likely possibility of HIV.

At this time, please do not take any muscle relaxants without consulting rheumatologists or orthopedic experts.

I hope this helps.

Thank you.