Question
Can I use PEP if I am HIV-positive?
24 October 2008. Related: All topics, HIV reinfection (superinfection), HIV transmission, PEP/PEPSE.
I am HIV+ and am lucky that my CD4 count is normal and I have not been put on meds yet.
Would it be ok to take PEP if I was worried about re-infection due to a recent encounter?
Answer
This is not a very good idea. Before using PEP people take a rapid HIV test to check that they are not already HIV positive.
This is because resistance can developed even from a short exposure to the medications. This is particularly true if the PEP contains an NNRTI.
If you were on treatment, theoretically this would give some level of pre- (PrEP) and post-exposure prophylaxis (PEP) against reinfection. However, this protections can’t be relied on as many of the documented cases of reinfection have been in people who were using HAART and had undetectable viral load. The rebound in viral load after being on stable treatment was actually how the reinfection was diagnosed.
Reinfection is a serious risk if your partner is resistant to drugs that you are still sensitive to, but may not be a risk otherwise. Knowing about you and your partners resistance and treatment history is therefore important if you want to chose not to use condoms.
If you don’t know that information, then condoms are the best way to protect you from reinfection.
If this has just happened once, then the risk of reinfection is likely to be low and
there is little you can do about it now.
You should tell you doctor about any risk of reinfection though, as this would be a reason to have a second resistance test before you start treatment (assuming you had a first resistance test when you were diagnosed).
Hope this helps.
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