[Question #10115] Special case after PEP

25 months ago

I'm helping my friend with a question.

My friend had unprotected sex with an HIV-infected person on May 3, and he was the recipient of anal sex. This infected person was not on ART after diagnosis in 2021 and currently has a viral load of 440,000.

My friend took PEP immediately 90 minutes after exposure with Biktarvy, which he took for 28 days. On the day of the last dose of PEP (May 24) the HIV third-generation test results were non-reactive. However, 26 days after the last dose of PEP (June 28), he had a reactive third-generation test and a non-reactive rapid test. Thus the laboratory performed a Western Blot test on him and found a GP160 band. Then he took an HIV fourth generation AgAb test 28 days after his last dose of PEP (June 30, today), which was non-reactive. Is it undergoing seroconversion or is it a WB false positive?

H. Hunter Handsfield, MD

25 months ago

Welcome back to the forum. I hope your own relationship (with a newly diagnosed HIV infected partner) is going OK, as discussed in your previous thread.

We are not experts in the most detailed interpretation of special HIV tests. In person care with a well established HIV expert physician or clinic is necessary. Probably these are false positive test results, and not a new HIV infection. (True positive Western blot usually shows at least three bands.) However, given the high risk exposure and the timing -- with these test results still too soon after completing PEP to be conclusive -- I cannot give you a firm answer on new infection (i.e. failure of PEP) versus false positive test results. Probably it will turn out he does not have HIV, but further testing will necessary; I'm confident your friend's doctor or clinic will agree with such a plan. He should follow their advice.

Sorry I can't give the conclusive answer your friend might have been hoping, but I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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25 months ago

Thank you. I would like to discuss about myself. My partner's viral load in May has been < 20 copies/ml, does this mean that any sexual contact with him is safe for me? Can I stop PrEP and how often do I need to be tested for HIV in the future?

H. Hunter Handsfield, MD

25 months ago

I'm glad to hear your relationship has stood up despite the obvious stresses this situation created for you and him. Good show!

Undetectable virus means HIV is not sexually transmissible. Don't worry about the official wording of test results, such as <20 copies. Twenty copies is the threshold for most NAATs for HIV RNA, so they cannot officially report "no virus present". But I am unaware of any reported sexual transmissions of HIV from persons with that test result, and many such couples stop both PrEP and condoms. HOWEVER, specific tests in use and their interpretation may vary geographically. I assume these same standards are valid in China, but you should confirm with your partner's doctors.

I'll be happy to comment once more about your friend's situation, if anything isn't clear. But anything more about your situation should be in a new thread. Thanks for your understanding.

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