Exposure Risk and PEP

[Brackett]

Hey,

First, ill explain the exposure.

I had unprotected sex with a female sex worker (I'm a man). We had sex for about two-four minutes when I noticed blood. We stopped right away and she said her period must have just started. I washed and she finished with oral sex.

After, I asked if I had anything to worry about, she said no. Tests often and always clean. That would have been only slightly reassuring, but became totally unreliable,e when a few days later I tested positive for chlamydia. Proving that she probably does not test regularly.

Anyway, I know how stupid it was but also knew to start pep.

I started a combivir only treatment 22 hours after exposure. Completed it with perfect adherence.

So - had my six week test (post exposure, as it is an antibody test, both the HIV specialist and family doc explained that PEP does not affect antibody testing, on,y viral load testing) and am waiting on results.

But, needless to say, I've been terrified for six weeks.

Have not gotten ill or anything.

Any experiences? Will PEP work? Has anybody known anyone it has not worked for?

[Jeff G]

Hi Brackett . Pep is very effective at preventing an HIV infection when administered within 72 hours post exposure . The fact that you initiated treatment at 22 hours is a huge plus in your favor as well as you being the insertive partner during intercourse .
I would expect a negative result . I have not seen a case like yours where the subject was adherent and began PEP within the 72 hour window period go on to test positive for HIV . 

You choose the word clean to describe a HIV negative person and that is offensive to many of us living with HIV , just food for thought . You can not go by what somebody tells you about their HIV status , the only way to know is to do as you have done and test at the appropriate time . Best of luck . 

   

[Jeff G]

Hey Jeff - thanks for the reply.

I can't believe what a dolt I feel like having used the term "clean" - was actually quoting her, but still horribly offensive/insensitive.

Please accept my sincere apology. And thanks again for taking the time to respond.

You are welcome . I know you didn't intentionally mean to offend but as HIV educators we feel its best to address language that contributes to the stigma people with HIV must live with . There is no need to respond to this and use up a post . I have quoted you and will remove your post where you responded to me so as not to use up a question .

Please use your post to come back and gives us the news you tested negative or for additional questions . Best of luck , Jeff . 

[Brackett]

Got my results back - negative. This being six weeks post exposure (2 weeks post pep).

Anxiety still high as there is so much conflicting info regarding the effect of PEP on testing. Even within the clinic. I will test again at 3 and six months, but it's hard to k ow where things are at now. Every scratch in my throat, bout of fatigue, warmth (even due to hot whether) throws me into a downward spiral of fear thinking that ARS symptoms are finally beginning ( especially being at 25 days post PEP, and 25 days being the average for symptoms).

Not sure what to do. Trying to take the first result as a substantial step in the right direction, but it's causing me to research how many people on PEP who test neg at six weeks later test positive.

Any insight on ANY of this?

Specifically:

1) was this first test all but pointless.
2) would ARS have been affected by PEP and am I just now entering the average time frame? Or would ARS have happened "on schedule" regardless of PEP?
3) have you or anyone ever seen a case where a six week test (2 weeks post pep) turn positive later on? Not as,ing about scientific odds, but any actual cases when it has happened?

Came back clear on Hep C, syphilis, chlamydia and gonorrhoea.

Thanks.

[Ann]

Brackett,

1) was this first test all but pointless.

All this test told you was that you were hiv negative at least six weeks before you started PEP. If you were tested before you started PEP (you should have been), you would have known this already.

2) would ARS have been affected by PEP and am I just now entering the average time frame? Or would ARS have happened "on schedule" regardless of PEP?

ARS is what some people experience while producing antibodies. Taking PEP will remove the trigger (hiv) for antibody production.

If PEP was not successful and the virus managed to get into areas of the body the meds can't reach, it will start to go back into the blood stream when PEP is stopped. It will then take the usual amount of time for the body to produce enough antibodies to trigger a positive antibody test result. The usual amount of time is three to six weeks.

3) have you or anyone ever seen a case where a six week test (2 weeks post pep) turn positive later on? Not as,ing about scientific odds, but any actual cases when it has happened?

I personally only know of one case where PEP wasn't successful and the mode of transmission wasn't anything remotely like yours. (It was a occupational deep needle-stick injury where the nurse had just that second taken blood from a man with an extremely high viral load (in the millions), who was very sick in hospital and on his death-bed. This is NOTHING like your situation.)

The earliest you should test again is at six weeks post-PEP. Provided you get the negative result I fully expect you will, then you need to confirm that at three months post-PEP.

You do NOT need to test out to six months post-PEP. That is an outdated guideline. Three months is sufficient.

I do NOT expect you to test positive. Good luck and try to keep busy with other things while you wait for the appropriate time to test.

Ann