The patient should be treated with postexposure prophylaxis with tenofovir-emtricitabine and raltegravir while awaiting the results of HIV testing. This management of significant HIV exposure is the same whether the exposure was occupational or nonoccupational. Baseline HIV testing is performed as soon as possible after exposure to ensure the exposed person is not already infected. Postexposure prophylaxis must begin immediately, however, without waiting for results. The preferred regimen for postexposure prophylaxis is a three-drug regimen of combination tenofovir-emtricitabine and raltegravir, which has been shown to be effective in reducing acquisition of HIV when used prophylactically.

Although higher levels of viral load are associated with an increased risk for transmission, knowing the partner's recent viral load level would not alter appropriate prophylactic treatment because even an undetectable viral load does not indicate no risk is present. Beginning prophylactic therapy should not be delayed while this information is obtained.

Combination tenofovir-emtricitabine is FDA approved for preexposure prophylaxis in those at significant risk for exposure. However, postexposure prophylaxis should involve a three-drug regimen of these two nucleoside analogues and a third agent, with raltegravir being the preferred agent.

Receptive anal intercourse qualifies as a potential significant HIV exposure and puts the exposed person at risk for infection. Although the likelihood of transmission may be reduced if the person who is the source of the exposure is receiving antiretroviral therapy, as in this patient, it is not lowered to zero. Therefore, awaiting the results of HIV testing without postexposure prophylaxis would be inappropriate.