Weekly/ February 12, 2016 / 65(5);110–114

Jason A. Wilken, PhD1,2; Christopher Ried, MD3; Pristeen Rickett3; Janet N. Arno, MD4; Yesenia Mendez5; Robert J. Harrison, MD1; Dan Wohlfeiler, MJ, MPH6; Heidi M. Bauer, MD6; M. Patricia Joyce, MD7; William M. Switzer, MPH7; Walid Heneine, PhD7; Anupama Shankar, MS7; Karen E. Mark, MD, PhD8(View author affiliations)

In 2014, the California Department of Public Health was notified by a local health department of a diagnosis of acute human immunodeficiency virus (HIV) infection* and rectal gonorrhea in a male adult film industry performer, aged 25 years (patient A). Patient A had a 6-day history of rash, fever, and sore throat suggestive of acute retroviral syndrome at the time of examination. He was informed of his positive HIV and gonorrhea test results 6 days after his examination. Patient A had a negative HIV-1 RNA qualitative nucleic acid amplification test (NAAT)10 days before symptom onset. This investigation found that during the 22 days between the negative NAAT and being informed of his positive HIV test results, two different production companies directed patient A to have condomless sex with a total of 12 male performers. Patient A also provided contact information for five male non–work-related sexual partners during the month before and after his symptom onset. Patient A had additional partners during this time period for which no locating information was provided. Neither patient A nor any of his interviewed sexual partners reported taking HIV preexposure prophylaxis (PrEP). Contact tracing and phylogenetic analysis of HIV sequences amplified from pretreatment plasma revealed that a non–work-related partner likely infected patient A, and that patient A likely subsequently infected both a coworker during the second film production and a non–work-related partner during the interval between his negative test and receipt of his positive HIV results. Adult film performers and production companies, medical providers, and all persons at risk for HIV should be aware that testing alone is not sufficient to prevent HIV transmission. Condom use provides additional protection from HIV and sexually transmitted infections (STIs). Performers and all persons at risk for HIV infection in their professional and personal lives should discuss the use of PrEP with their medical providers.

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