Condom broke PEP within 28 hours

[ohce]

I visited a thai prostitute (ladyboy) when i was very drunk. Unfortunately the condom broke during ANAL sex, was approximately exposed for 30seconds and i was put on a PEP treatment within 28 hours: Reyataz, Truvada and Norvir.
I have had a great deal of stress during this period, and experienced numerous side effects which could be linked to the drugs. At day 20 I developed a sore throat which is still there at day 34 now (few days after my treatment ended). Now i have some weird symptoms in my mouth:
- Mainly some red enlarged bumps on the tip of my tongue
- A few white bumps around the tongue inclusive the sides.
- Some small sore around the inner cheeks.
- Some irritation at both end of the mouth where the lips meet.
This freaks me out! I am very scared that the PEP has failed. Could this be a sign of ARS?

[RapidRod]

You need to test 3 months post your last dose of nPEP for a conclusive test result.

[ohce]

If i think i am experiencing ARS right now, how long time do you think it will take before an antigen test will show positive? Isn't usually within a few weeks? Would you define my risk as a high risk encounter, and was it okay to put me on PEP?

[Andy Velez]

No, I would not consider yours to have been a high risk incident. In fact I wouldn't have even thought PEP was the thing to do. But you are doing it and so you need to test at 13 weeks after the completion of PEP. You can do an initial stest at 6 weeks post-PEP. Assuming you get the negative result I expect you to receive, then the likelihood is that you will continue to test negative.

None of your symptoms are in any way HIV-specific. If any of the continue you ought to discuss them with your doctor.

Ultimately I expect you to come out of this ok.

[ohce]

Andy your response did definitely release some tension, but due to my risk my anxiety wont be gone totally before I've had the test 3 months post the last dose. I do however have some questions, I hope you can be helpful with. During PEP i experienced the following side effects:
- malaise
- joint pain (on/off)
- neck pain (on/off)
- lack of energy (tired)
- yellowing of the skin (which went away after taking the meds with food)
- sore throat
- weight loss in the neck/face area

Some of the side effects were probably a combination of the drug and the anxiety i was experiencing.
I didn't get fever, enlarged lymphs nor rash. It has now bin 7 days since my last dose, and during this period some of the side effects have been remaining. The side effects are mainly on/off pain in the neck region (just about the area where the hair starts) and on/off joint pain. The pain suddently strikes me, i get anxious, and I think i might feel the double effects because of this. But I think it's getting better every day. But back to my questions:

1. How many days does it take for the medication to get out of your system, hence to get rid of the the side effects due to PEP?

2. Are joint pain and pain in the neck area a common sign of ARS or a PEP treatment?

3. Is a 3 drug pep regimen with two NRTI and 1 boosted PI taken for 28 days with 100% adherence unlikely to fail? My question is more in the direction of, why does PEP fail? Is it resistance, adherence, duration or any other parameter that determine this?

[Matty the Damned]

Ohce,

Symptoms really mean nothing when it comes to diagnosing HIV infection. It's about identifying risk behaviours and then testing at the right time.

As Andy notes your risk was not great and I agree with him that PEP really doesn't seem warranted in your case. However you were at risk and you need to be tested 13 weeks from the end of your PEP regimen.

The effectiveness of PEP is a subject of constant research and we cannot provide you with any particular answers about regimen failure. You might want to review our Lessons and read up on the relevant facts regarding PEP. You will find the links to our lessons in the Welcome Thread.

I expect you test negative, you should expect the same.

MtD

[ohce]

I hope and expect the same, but new studies has shown higher HIV concentration in rectal mucosa secretion than in blood and semen (http://www.jstor.org/pss/30077597). So even though the exposure was brief, there would still be a significant amount of HIV virus around, free to enter my body through the urethral opening, which should mean that PEP was the correct thing to do? But what I really wanted to know, was how long it takes before the drugs is out of my body?

[Andy Velez]

You're not helping yourself while waiting to be able to test by trying to nail down details when only the test result will give you the answer you need.

You'd be a lot better off by concentrating on other things in your life. Don't bother saying you're too worried to do that because I can tell you that response won't fly here. You can do it and it will make the waiting time go much more easily than what you are putting yourself through now with this obsessive quest for answers.

And yes, I still do expect you will test negative.

[ohce]

Usually, the clinic are doing some tests immediately following the end of a PEP treatment. The doctor recommended me to wait a few weeks before taking the tests to see if the medicine had done any harm and at the same do an antibody test. Even though some numbers did raise compared to baseline numbers, they were all still in the normal region. The antibody test came back negative. The test was done 41 days post exposure and 11 days post my last dose of PEP. This adds up to all most 6 weeks post exposure. Based on other post in this forum, I understand that if I hadn't taken antiviral drugs, a negative result at 6 weeks would be highly reassuring. What does it mean knowing the fact that i did take the drugs? Does this corresponds to taking an antibody test at the 2 week mark, and is it therefore useless?

In the original post, I was complaining about the side effects of the drugs versus the side effects of acute HIV (ARS). I was very worried about a sore throat showing up at day 20 and lasting for all most 2-3 weeks plus some joint and neck pain. Is it safe to say that if I was experiencing ARS at day 20, i would have enough HIV antibodies in my blood to be picked up by a test by now?

[Andy Velez]

Let's keep this simple. You understandably want to have a reliable negative result as soon as possible. But the fact is that for a final result you need to get tested at 13 weeks past whenever you finished/stopped PEP.

A negative result at 6 weeks past that time would be very encouraging and point to a likely negative result at 13 weeks. Everything else is guesswork and just won't give you the answer you want.

Your risk was a low one to begin with. Once again I will say I expect that you will ultimately test negative.

[Ann]

ohce,

If you were seroconverting around day 20 despite the meds, yes, you would probably have had enough antibodies by the time you tested. PEP does not directly stop antibody production - it reduces and often eliminates the amount of virus present in the blood, so there is less there to stimulate the immune system into producing antibodies. If the PEP was failing to suppress the virus, it is possible to create the antibodies.

You're ignoring the most important factor here - namely that as the insertive partner during a condom break during anal intercourse, you were never likely to become infected, PEP or no PEP. I fully expect you to continue to test hiv negative and so should you.

Ann

[ohce]

Andy, what you are telling me is basically the answer to my question. The drugs resets the timeline unless the virus was completely - 100% resistant to the drugs, and therefore is this test at day 41 more or less useless to give any indications. Yes, every speculation from this point on whether the drugs worked will be a guesswork and it would be unwise to do so, since my time can be spent being more productive. I just wanted to here your opinion about my test. As i told you, the clinic required to do the test to follow up on how well i responded to the drugs and how much damage they had done.

Ann, I do acknowledge that my risk was low. I was very worried the first month, and the side effects from the medicine didn't help at all. Since time has elapsed, I am getting better every day, and I am starting to focus more on getting on with my life and not let my HIV concerns get a hold on me. You have just told me what I wanted to hear There is a link between ARS and seroconversion. My side effect concerning the first month was probably not duo to ARS but a symptom of the meds and anxiety.

Thank you both for your answers. I wont post again until I have had my next test. The clinic recommended me to come back in 2 months, but I think i'll just wait 3 month and get a conclusive answer.

[Andy Velez]

OK. And good luck with what both Ann and I still expect will be a negative result.

[Ann]

ohce,

The symptoms that some, but not all people experience during seroconversion are not directly caused by the virus. They are caused by the process the body goes through while producing antibodies.

Ann

[ohce]

I have had a very very sore throath 8-9 week post exposure (4-5 post PEP) which made me worried.
12 weeks post exposure test just got back, and they are negative! I think this will be the end of my story. According to many independent sources the "new" 3rd generation tests will detect the vast majority of HIV infections 4-6 week post exposure. An article in medscape adresses the same issue just with people that have had PEP.
"As nearly three-quarters of eligible study participants did not return for follow-up at 6 months after exposure, our data cannot be seen as definitive evidence of the efficacy of NPEP. However, there are three reasons suggesting that it is unlikely that we missed NPEP failures. First, all the 850 people who had an HIV test at 4 or more weeks after exposure were HIV negative at that time, and the sensitivity of the HIV serological test is such that the vast majority of NPEP failures would have been detected then. Secondly, those who returned for the 4-week follow-up tended to be at higher risk than those lost to follow-up (data not shown). "
http://www.medscape.com/viewarticle/561086_4

If I was infected due to the brief exposure this test at 12 weeks post exposure and 8 weeks post PEP, would have been positive. I'm very reliefed and I will take a test again within 3 month just to be absolutely sure. But i'm convinced that this will not change, and i will start to move on. I will make the changes, so I don't end up in a situation like this again. I'm very thankfull that the lightning didn't strike me, and I will in the future do what ever I can to help people. This experience is a life changer.

Thank you for your support.

[Ann]

ohce,

I also do not expect your three month post-PEP test to be anything other than another negative.

I'm not surprised - I've yet to see the insertive partner end up positive following a condom break and I didn't expect you to be the first.

Please read the condom and lube links in my signature line so you can be sure you're using them correctly. A correctly used - and stored - condom rarely breaks.

Ann