MDM //

Otherwise healthy with moderate risk HIV exposure (unprotected vaginal sex with HIV+ patient albeit with unclear last CD4 + VL)_. Extensive discussion with patient regarding risk of transmission in regards to Hep B/C, RPR, G/C and HIV and relative rates given source patient and mechanism. Patient declining vaginal exam to evaluate for tears at this time after risks discussed with full understanding and capacity. Discussed PEP at length with patients and after review of primary risks, benefits and alternative, given risk of transmission, mutual decision making to use PEP at this time. Discussed prompt follow up with clinic for bloodwork and serial serologies. Discussed at length regarding consensual nature of sex and patient does not feel that encounter was not consensual. Discussed that if patient changes mind, given STI treatment center resources. Patient contracts to safety and feels safe at home. Given history, per CDC (2013) and NYSDOH (2014), patient not pregnant and will treat with Tenofovir 300 mg PO daily + Emtricitabine 200 mg PO daily + Either Raltegravir 400 mg PO twice daily. Discussed post exposure testing at baseline6 weeks post-exposure, 12 weeks post-exposure. 6 months post-exposure at clinic. Will provide 5 days of PEP_ but discussed prompt need for follow up and full course being at least 4 weeks. Cautious return precautions discussed w/ full understanding.



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