Please kindly help me

[parysUK]

Hey
I have very strange and worrying situation
I normally take prep on deman
On the 25/7 I had unprotected sex I was bottom with the guy
His confirmed few times to me hi is on prep and hi is all fine
Sadly I took double dose just after sex the followed with 1:1 as usual .
Then I had unprotected anal (bottom ) sex with the guy on  the 27/7 which was covered by last dose of prep from the previous encounter I hope but I carried on with another 2 days of pils   just to be sure
Then on the 4/8 I had sex with guy while I was in the other city and I was top but didn’t had my pills with me so I took double dose probably 2h after sex  instead at least two hours before 😩when I got home and the followed with usual 1:1
I took oraQuick on the 12/8 negative as at that time I wasn’t concerned
I decided to get back again on  prep daily from that day 12/8 after oraQuick
Then I had INSTI IgM/IgG  on the 14/8 and another one on the 18/8 both negative
I know I have to take one in the clinic as I’m well in the window period but I’m just wondering if that prep gave some protection as sadly now I came down with bad fever no other symptoms just high fever and headaches .
Now I need to stop prep as apparently can delay antibody

[Jim Allen]

His confirmed few times to me hi is on prep and hi is all fine

Irrelevant. Nothing he says means anything, also even if he tested today it means nothing due to the window period. As for him being on PrEP, who knows if that's true or if he is taking it correctly and even if he is that's nice for him, but it doesn't mean much to you.

On the 25/7 I had unprotected sex I was bottom with the guy
Then I had unprotected anal (bottom ) sex with the guy on  the 27/7 which was covered by last dose of prep from the previous encounter I hope but I carried on with another 2 days of pils   just to be sure

You had anal sex on Thursday, the 25 July 2024 and again on Saturday. So the correct event-based PrEP procedure would be as follows:

Thurs - 2 PrEP pills before sex (2-24 hours before)
Fri - 1 PrEP pill
Sat - 1 PrEP pill
Sun - 1 PrEP pill
Mon - 1 PrEP pill

The reason for the additional Sunday and Monday dosage is that you had sex on Saturday and you need to continue taking PrEP for two more days after you last had sex. This is how event-based PrEP works.

https://i-base.info/guides/prep/on-demand
https://i-base.info/guides/prep/real-life-examples-for-on-demand-dosing

I’m just wondering if that prep gave some protection

Yes, but it's not ideal. The double dose before sex is important.

I decided to get back again on  prep daily from that day 12/8 after oraQuick
Now I need to stop prep as apparently can delay antibody

The delayed detection (blunted HIV infection) was and is always part of the risk when using PrEP. Nothing has changed. This also happens with PEP, hence with PEP the rule of thumb, is to apply testing guidelines post-finishing PEP instead of post-exposure date.

As for daily PrEP users, we don't encourage stopping and instead urge screening with a blood-draw (lab) HIV antibody test (Not a rapid test) every three months. The reason is stopping would mean having periods with reduced protection and with HIV screening every three months even a blunted infection would be detected within the first or second screening dates. This is far less of an issue with event-based PrEP as the standard window period changes by 2+- days only after the risk event.

Ultimately it's up to you, but I see two options.

1) Stop PrEP and test in six weeks with a blood-draw (lab) HIV antibody test.
2) Continue daily PrEP and test every three months with a blood-draw (lab) HIV antibody test.

Urging on the side of caution as you have had a haphazard PrEP past, I would say stop and test in six weeks to confirm your HIV status but talk to your healthcare provider.

In addition, should you ultimately decide to continue with daily PrEP or event-based PrEP in the future as an additional layer of HIV prevention then please start using it correctly!

Here's what you need to know to reduce your HIV risks:
Use condoms for anal or vaginal intercourse correctly and consistently, with no exceptions. Consider taking PrEP as an additional layer of protection against HIV and get vaccinated against HPV, Hepatitis A & B.

Keep in mind that some sexual practices described as safe in terms of acquiring HIV still pose a risk for other easier-acquired STIs. So please do get tested at least yearly for HIV & STIs, and more frequently if condomless intercourse occurs. As a PrEP user get an HIV screening every three months.

Also, note that it is possible to have an STI and show no signs or symptoms; testing is the only way to know.

Kind regards

Jim

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[parysUK]

That’s the doses I did followed from 25th/August till -30t/agust
which also covers my 27th encounter I do believe
Thurs - 2 PrEP pills before sex (2-2
Fri - 1 PrEP pill
Sat - 1 PrEP pill
Sun - 1 PrEP pill
Mon - 1 PrEP pill
Then no prep till the 4th when I had unprotected sex when I took double dose roughly 2 late   and followed same pattern 1:1 after
I know people saying things means very little this days hence I spoke with my sexual clinic and stoped prep having blood test tomorrow then another one on the 45th day after event

[Jim Allen]

That’s the doses I did followed from 25th/August till -30t/agust
which also covers my 27th encounter I do believe
Thurs - 2 PrEP pills before sex (2-2
Fri - 1 PrEP pill
Sat - 1 PrEP pill
Sun - 1 PrEP pill
Mon - 1 PrEP pill

On the 25/7 I had unprotected sex I was bottom with the guy
His confirmed few times to me hi is on prep and hi is all fine
Sadly I took double dose just after sex the followed with 1:1 as usual .
Then I had unprotected anal (bottom ) sex with the guy on  the 27/7 which was covered by last dose of prep from the previous encounter I hope but I carried on with another 2 days of pils   just to be sure

No, don't change the story as it will piss me off.

You said it was after sex, now you are saying you took it before sex.
You also initially said you thought the sex on Saturday 27th was covered by the last dose from the previous encounter, at that time the last dose was the Saturday dose, the sex on Saturday wasn't "covered" by this as it would require a Sunday and Monday dosing to reduce the HIV risk. 

Now, thankfully you took PrEP for the 2 additional days and that does provide some risk reduction "cover it". You need to understand for the future the correct process, not that its "just to be sure" as you put it.

Then no prep till the 4th when I had unprotected sex when I took double dose roughly 2 late   and followed same pattern 1:1

Same mistake as you made on the 25th. You took the double dose after sex, not before.

I know people saying things means very little this days

It never did.

I spoke with my sexual clinic and stoped prep having blood test tomorrow then another one on the 45th day after event

Perfect.

Let me remind you that condoms when used correctly and consistently are nearly 100% at preventing HIV from being passed on. Their level of prevention of other STIs is much lower. 

PrEP provides a good additional level of HIV prevention when used correctly and consistently, although no STI protection.

Since you no longer are using PrEP remember to use condoms and when you get your HIV screening done 6 weeks post exposure also talk to the clinic about an STI screening and getting vaccinated against HPV, Hepatitis A & B.

[parysUK]

No I’m ever so sorry I just looked I got it all meddled up 😩 from what I can see in my comment
25/7  double dose before sex then carried on till 1:1 :1:1 till 29th
Hence I said 27th encounter should  be covered into this
Then on the 4th I took the double  dose late 2 hours after sex then did usual 1:1
I’m so sorry for confusion
So the case of concern is for the 4th of August I understand as I was late with the dose
And was no prep from 29/7 till 4th

[Jim Allen]

Thanks for clarifying.

Test in six weeks to confirm your HIV status, and get vaccinated against HPV, Hepatitis  & B. Start using condoms, correctly and consistently, with no exceptions and if you do restart PrEP make sure to take it correctly for it to offer an additional layer of HIV prevention. 

[Jim Allen]

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[parysUK]

Hi All I really would appreciate some answers .
16th of August I came down with very strange illness and sypmtoms after some  unprotected anal sex on the 4th (I was Top ) in the 13th I was bottom and 15/08 I was bottom .
I know sypmtoms are very tricky and we need to not judge by it unless they are bluntly obvious .
On the 17th August I woke up with bad fever and shakes no sore throat or rash just pains all over and bad fever that lasted 2 days and since then we are 27/september I’m still not well at all .
Obviously I connected the dots in my head and on the 19th August went to my sexual clinic for check up and also Had full blood screen with my GP on the 29 August all full blood count and CRP protein , all normal .
My testing
20th August baseline test
Him 4th gen from the vain all negative
In the meantime I went absolutely crazy with fear completely lost it .
21/08 INSTI rapid negative
23/08 INSTI rapid Negative
28/08 INSTI rapid Negative
29/08 rapid cassette test from Higgins trust negative
31/08 INSTI rapid negative
2/09 Lab 4th gen  test finger blood sample send to the lab (Fettle service ) negative
6/09 lab 4th gen test at my sexual clinic blood from the vein . Negative
11/09 INSTI rapid negative
15/09 INSTI rapid negative
21/09 INSTI rapid negative (37 days after last contact 15/08 )
Today I had results from sending blood sample to the PREVENTX
They use 4th gen assay Ag/Ab and p24 that test simultaneity for ab and p24 and give separate results for boath All Negative
41 Days after exposure How confident I can feel it’s all ok 😩
I have last test scheduled at my locat heart clinic for the 30th of September exactly 45 days as uk guidance so I’m only short 4 days
Is my 41 is likely to stay the same ?
I’m only asking as I’m still not well got a swollen lymph node on my neck and very small one behind my ear that hurts
Some people say even if it’s 4th gen test blood send to the lad from finger it’s not as accurate as it’s not from the vain
I’m so exhausted of that journey and mentally I’m completely done
I would really appreciate some views and answers please

[Jim Allen]

So the 4th you had condomless intercourse. On the 13th and 15th of August you also had condomless intercourse.

 I presume you were not taking PrEP?

Instead of waiting to test you started the merry-go-round of useless rapid testing and it didn't help and means nothing and 41 dys afterwards you sent off a flinger prick blood sample, equally pointless. You don't live in a resource poor region of the world and it's a national health service system.

Go to the clinic and get a proper STI and HIV screening, make sure they are aware of your last exposure date.

[Jim Allen]

16th of August I came down with very strange illness

On the 17th August I woke up with bad fever and shakes no sore throat or rash just pains all over and bad fever that lasted 2 days and since then we are 27/september I’m still not well at all .

Nothing to do with HIV whatsoever.

If your results from the clinic are nonreactive I recommend you discuss starting daily PrEP with them for peace of mind going forward, condoms usage and consider talking to a therapist as freaking out over sex and panicking isn't healthy or happy

[parysUK]

Hi Jim
I’m not sure if I chosen wrong day to ask 😭 as reply is little harsh and I truly only wanted some advice .
Yes that’s the correct dates of encounters however I took prep 2h after sex instead before  (event dosing)     the that encounter ion the  4th and finished normally  the event dosing
So the issue only with that encounter is that I was 2 h late
 then  I was on prep from 12/08-16/08 as I decided to get back on daily pill but I stopped on the 17th as I started to feel ill and I didn’t wanted prep to delay anything etc probably stupid decision
So the encounters on the 13/08 and 16/08 were in the week I was taking prep
Self Sample send  to the lab pointless at 41 days ??
They use exactly same test assay that my sexual clinic uses the only difference is you take sample yourself not vain drawn
Elecsys HIV Duo is an immunoassay intended for the in vitro simultaneous qualitative detection and differentiation of HIV‑1 p24 antigen and antibodies to HIV, HIV‑1 (groups M and O) and HIV‑2 in human serum and plasma.
I only asked for some reassurance if 41 days is good indication???  as it’s only 4 days short
And yes of course I do go on the 30th when full 45 days is up to have blood drawn
I obviously know that other ISTi rapid test I took excessively are not to use for that situation but like everyone one or most I was panicking .
I’m sorry if I anyway sound stupid but I don’t think any question from Someone very worried is tupid

[Jim Allen]

Thanks for the update.

At of this has been asked and answered. The symptoms have nothing to do with your HIV status, as for what your HIV status is test when due as recommend.

Regarding PrEP, on demand PrEP isn't working out for you and I strongly recommend you discuss switching to daily PrEP (or injectable PrEP if they have it).

[parysUK]

Thanks
So would you say 41 days after exposure 4th gen tests give good indication for 45 days one ? That’s all I asked essentially
Regards
Parys

[Jim Allen]

Any nonreactive result is nice but the rapid and postal testing history is excessive and a waste of resources, it doesn't give you the result needed or peace of mind.

you again are posting about PrEP mishaps and lack of condom usage followed by excessive panic and stress.

It's not healthy, I don't want you to end up having HIV or to leave you to continue with an unhealthy cycle of fear, panic and pointless testing when correct consistent condom usage or at least correct PrEP usage and routine testing will do fine with perhaps some therapy.

[parysUK]

Thank you Jim
I appreciate your comment
I’m 47 and never thought I will spiral sooch out of control with my mind and worry to literally point my life is on hold due to this
After this is all ruled out  of course I’m back religiously in my daily prep I can tell you this .
I agreed rapid testing was so excessive that I think I was mad to do this but it was driven by fear Jim not everyone can just sit and say to them self ok it was a risk I will test in clinic in appropriate time and chill till then .its just not how 45 days of waiting in fear works but I’m sure you heard it all again and again .
41 day test sensed to the lab they recived sample next day and tested day after with what they call 5th gen as it gives results separately for p24 , ab , and subtype of him etc
Anyway I just wanted to check with your experience of 41 day test like that is good sign but I guess it’s again just looking for reassurance
And just to say I admire what you do on here for people it’s an incredible work that must to take most of your time .
Regards
Parys

[parysUK]

So my 46 days after exposure 16/8 out of window test   all came back clear .
Blood drawn from the vain in Sexual clinic amd send to the lab 4th gen test I live in UK
Could I kindly ask if that’s all testing done for re HIV as I haven’t had any contact with anyone since 16/8
I spoke  with health adviser and she said that no more testing is required as in uk the window period is 45 days .
I just want to put all the subject to sleep and move on and start my daily prep .
However some organisations recommend 8 week window and it can be bit confusing 😩
I would really appreciate answer

[Jim Allen]

If you read back your thread this has been already answered.

Anyhow, a nonreactive result on a blood drawn laboratory HIV antibody test six weeks post potential exposure is generally considered confirmed and retesting at three months is generally not necessary. Being in the UK doesn't change that.

You have tested six+ weeks post potential exposure, it's nonreactive, you don't have HIV, time to move on with your life.

[parysUK]

Hi Jim
Thank you so much for your patience and reply truly .
Could you please offer advice !
Is there any advice or protocol to test past 6weeks/45 days period .
The reason I’m asking this is not because I’m still eaten with worry but for more medical reasons .
As you know from the previous posts my last exposure was in the 16th of August
And since that time I’m still very unwell .
I followed testing protocol with my sexual clinic with 4th Gen blood drawn tests
I tested on the 20/8 baseline test
None active
Then on the 2/09 finger blood collected and send  to the lab 4th Gen None Reactive
06/09  Blood drawn from vain at the sexual clinic none reactive 4th gen
Then 24/09 Bllod collected from the finger and sensed to Preventx lab
5th Gen Assay (Gives separately  results for Ab , p24 , and hiv subtypes .
None reactive
And finally 6 weeks post exposure final lab test in my sexual clinic all clear ,
However my Gp ordered some bloods as I’m still so unwell physically that hi really tries to find the cause
Not gonna go the route of symptoms but still got lympnode on my neck and behind  my ear , pretty much house and bed bound as I literally feel like I’m going through flu everyday with on and off fevers for past few weeks and pains all over my body
All labs came back normal
Liver , CRP , Kidneys , EBV negative as I had it in the past unless it reactivated itself 🤔
However and I know it’s nothing that is the one should look I get it but my WBC is down since my last blood work with my go  on 29/8 WBC 7,6 now they are 6,3 still in normal levels that are 4-11 but a drop indeed .
My question is there any advice to test over 45 days post exposure  as I know those tests are goddamn sensitive right .  And I had few if them but is there a possibility to have some viral illness that would affect my testing ?

[Jim Allen]

The symptoms have nothing to do with your HIV status,

You have been told by the health advisor, presumingly at the clinic that no further testing is required. I have also explained to you that you don't have HIV and that your symptoms have nothing to do with HIV.

Are on writing me whilst dying in hospital? 
Are you a long term IV drug user?
Are you currently undergoing chemotherapy?
Are you taking PEP or PrEP?

[parysUK]

First Thank you very much for answering
And No I’m not in hospital bed
I don’t use drugs
I’m not on any chemo
And I’m not on pep , and haven’t restarted my prep yet as I don’t plan to have any sex anytime soon I’m to unwell for that,   nor I   had   any encounter with anybody since 16/08 
Yes that’s what they say but tbh in uk in sexual clinic you seeing health adviser nurse not a clinician so actually I found more information on this forum than from them
As last time when I asked what’s the best way to restart my prep after my 6 week clear all clear result the nurse had no clue and had to ask her colleague that is train on prep which didn’t made me very confident 
Anyway I just wanted kindly to get your input on guidance for testing out of window period that’s all . 

[Jim Allen]

First Thank you very much for answering
And No I’m not in hospital bed
I don’t use drugs
I’m not on any chemo
And I’m not on pep , and haven’t restarted my prep yet as I don’t plan to have any sex anytime soon I’m to unwell for that,   nor I   had   any encounter with anybody since 16/08

Perfect, so your symptoms have nothing to do with HIV, if your left testicle and arm drops off tomorrow, it's still not HIV from the concerned encounter. You have tested, you don't have HIV.

Yes that’s what they say but tbh in uk in sexual clinic you seeing health adviser nurse not a clinician so actually I found more information on this forum than from them

The majority of nurses in these clinics will know more than the doctors you will see, and I am not surprised you found additional information here, it is all we focus on here, nothing else.

my WBC is down since my last blood work with my go  on 29/8 WBC 7,6 now they are 6,3 still in normal levels that are 4-11 but a drop indeed .

WBC count tends to go up and down, that's normal. For example, they will be lower in the morning and higher in the late afternoon, and two draws even within an hour of each other will produce totally different counts, up and down, that's normal.

I just wanted kindly to get your input on guidance for testing out of window period that’s all .

I understand but it's been asked and answered. Stop focusing on HIV as it isn't the cause of your problems and continuing to test or focus on HIV is a waste of your time.

I wish you well but we can't assist you here further. You don't have HIV, keep working with your doctor to treat whatever is making you feel unwell and I hope you feel better soon. Please do not post about this again.

Anyone who continues to post excessively, questioning a conclusive negative result or no-risk situation, will be subject to a four week Time Out (a temporary ban from the Forums). If you continue to post excessively after one Time Out, you may be given a second Time Out which will last eight weeks. There is no third Time Out - it is a permanent ban. The purpose of a Time Out is to encourage you to seek the face-to-face help we cannot provide on this forum.

[parysUK]

Thank you Tim you’ve been very kind to answer  👌 
Appreciate the joke about arm dropping off tomorrow 😎👌