Would an RNA test or Antigen test today be accurate?

I have tested every week throughout pep treatment, always negative. If I had seroconverted during this time then it would have shown up as positive, right? I had developed white tongue a couple weeks ago but test negative and today I have a painless red patch on the side of my tongue. No other symptoms besides some muscle / lymph area aches. 

Honestly, I would have recommended against PEP in this situation; had you been in my clinic, we would have refused to prescribe it. The vast majority of female CSWs in the US and other industrialized countries do not have HIV; when infected, without a condom the transmission risk is around once for every 2,500 exposures; and condoms lower that risk by at least 90%. If we assume one chance in a thousand your partner has HIV, your maximum risk of HIV would calculate as 0.01 x 0.0004 x 0.1 = 0.0000004 or four in 10 million, i.e. one chance in 2.5 million. Which means zero for all practical purposes. You might keep this sort of calculation in mind in event of future sexual exposures!

That's water under the bridge, of course. To your specific question:  There are no good data on time to reliable testing to detect HIV if infection occurs despite PEP. The "problem" is a good one, though:  there are so few cases of infection following PEP that no reliable research can be done on the frequency at which it fails. Therefore, all advice on the subject is limited to research in test animals done several years ago (in which 100% become infected without PEP, a super unrealistic standard); plus judgment based on the known immunology and pathogenesis of new HIV infections. In other words, educated guesswork. That guesswork leads some experts to believe that negative test results are valid immediately after completing PEP, and others to recommend testing at anywhere from a month to three months after the last drug dose. On this forum, we are confident that 6 weeks is a reliable interval, so my advice would be have an antigen-antibody (AgAb, 4th generation) blood test about 6 weeks from now. A negative RNA test two weeks after the last dose probably is also conclusive. Negative results before then are very reassuring, but I would not consider them conclusive.

It is not possible to have s symptoms due to HIV and for the HIV blood tests to be negative. So even if you current results do not necessarily mean you didn't acquire HIV, they do prove that your oral symptoms have nothing to do with HIV. Same for your body aching.

A bottom line about PEP goes back to my opening comments. Often neither exposed persons nor the prescribing doctors think about the downside of prolonged worry, i.e. the added time to conclusive testing after completing treatment.

Anyway, if I were in your shoes I would not be at all worried, because there is no realistic chance you acquired HIV in the first place. In fact, I would not have even recommended testing for it, let alone PEP! So stay mellow as you wait for your upcoming future test results.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

I did not know that symptoms would always correlate with a positive test - that is very reassuring. Is this the case even while on pep? or is it not possible to have symptoms while on pep either? If I were to be positive in a week or two, would that mean that the pep cause delayed seroconversion?
I will do an Antigen and RNA test tomorrow, 1 day post PEP completion and then will do an RNA test at 10 days and Antigen at 14 days - would this be conclusive?

Should I hold off on sleeping w/ my partner until after another 2 weeks has passed?

I currently have a smooth red patch on the side of my tongue, no pain, no blood, i also have a stiff neck and some body aches, that have been going off and on since the encounter - could this be syphilis? 

Yes, symptoms of HIV cannot happen without positive tests; being on PEP makes no difference in that.

I'm sort of reluctant to respond further. You truly didn't need testing at all, and your PEP and all these tests are way over the edge of common sense and reality. But our usual advice is likely to sustain your fears, because I can only say that your planned test schedule probably will be conclusive, but in the absence of data advise a conservative course. But even without testing, you should have zero worries given your zero risk exposure plus PEP. I would consider a 2 week post-PEP RNA test to be conclusive, but our usual recommendation also includes an AgAb test at 6 weeks.

Honestly, you're really overdoing all this -- although I understand the motivation in view of your  "general health anxiety". Even with such anxieties, if I were still in my dating days and in your situation, I would never have even had an HIV test let alone PEP.

In the nearly 20 years of this and our previous forum, with thousands of questions from persons worried about HIV, not one has yet reported s/he tested positive. You're not going to be the first. If and when it finally happens, undoubtedly it will be a genuine exposure, like unprotected anal sex between men or sex with a known infected partner -- and certainly not a nearly zero risk situation followed by PEP.

And that completes the two follow-ups included with each question and so ends this thread. Do your best to stop worrying; there is no way you have HIV.