[Question #10436] Realistic chances ?

23 months ago

Good evening. High risk exposure (insertive anal on trans, broken condom). They state negative but no proof. For a fact, they would drop the protection and have with others. Based on that, 50/50 chance regarding her status. Exposure in July and on Pep 48 hours later. Took all doses daily and on-time with the exception of one or two that were within the hour. Two weeks into PEP, I developed a red throat. No pain & nothing else, just red. Also developed some type of rash on my hands. Non-itchy but looked like light red dots spread out. Also, my fingertips were also extremely dry. My hands cleared up within a week but the throat was still red, very red. The next two weeks my mind plays tricks on me which is expected. Finish the pep and test with a 4th gen 1 day post pep (30 days pos exp) -negative. Two weeks later, 19 days post pep (48 days post exp) I test again with a full STD panel-negative for everything except HSV1. Two weeks later, 29 days post pep (58 days post exp), I test again with a 4th gen-negative. Now, my throat is still red and now starts hurting when I swallow and my tonsils are inflamed. I also started to feel "blah" like a fever was coming but one never came. I take a 600mg ibuprofen and it works for some slight relief. As of today, one tonsil has now developed a tonsil stone or puss bag, not sure. Throat hurts alot when I wake up and I feel like shit until I take the ibuprofen again for relief. The only other symptoms I have had the entire time is diarrhea. Always thought it was because of PEP until I realized that I still have it although I still pass normal stools occasionally. I know things are in my favor "statistically" but from your experience and knowledge, what does it look like here ?

H. Hunter Handsfield, MD

23 months ago

Welcome to the forum and thanks for your confidence in our services. And also for reading other questions similar to your own (which I assume on account of your closing sentence). I can help!

Your self assessment that "things are in [your] favor...statistically" understates the situation. It is nearly 100% certain you do not have HIV. First, I would have rated the exposure as lower risk than you did; I doubt there was anywhere near a 50% chance your partner had HIV. In general, people rarely lie when asked directly about HIV status. Second, the risk of HIV from a single episode of unprotected insertive anal sex with an HIV infected partner is around 1 in a thousand. Third, PEP within 48 hours is very reliable.

Fourth and most important, your negative test results are nearly conclusive proof you were not infected. The symptoms you describe make no difference: it is not possible to have symptoms caused by HIV and test negative for the virus and anti-HIV antibody, so your negative AgAb (4th generation) blood test 29 days after your last dose of PEP mean your symptoms were caused by something else. (And your symptoms were not at all typical of HIV/ARS anyway.)

While your test results so far prove your symptoms are not caused by HIV, they still are not quite conclusive. Most experts advise a final AgAb blood test 6 weeks after the last dose of PEP (to be more precise, 45 days), so have another test at that time. Given the odds just discussed plus your test results so far, you definitely can expect another negative result, so stay mellow until that time. (In 20 years and thousands of similar questions, we've never had a forum user report they eventually tested positive for HIV. You certainly are not going to be the first!)

I hope this response is helpful. Let me know if anything isn't clear.

HHH, MD

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22 months ago

Good evening Dr.H. I appreciate the reply and it's a pleasure speaking with you. I did read other questions on the forum and this site is very informative. I wanted to mention that yesterday but wanted to make sure I was able to fit in all the specifics first.

Your reply is appreciated and comforting. One in a thousand is rare but at some point there still has to be a "one", no ? Unfortunately, the negative in me keeps thinking that.

I also wanted to confirm that the newer symptoms (sore throat, fever like feeling) appeared a couple of days after my 29 day post pep test so technically the test would have not picked that up although it does count for just the red throat and rash. I felt confident until new symptoms appeared after my PEP completion. This is my fear.

I guess my main concerns are, how often have you seen or heard of someone testing negative at 29 days and then positive by 45-90 days ? I know delay by PEP is an iffy subject but we can't rule it out, right ? One of my PEP pills was Truvada. Do you think I would have tested positive already had PEP failed ?

Also, my STD panel was all negative (except HSV1) at 6 weeks post exposure, do you recommend I test again ?

Lastly, I used STDcheck.com to order my tests and the test were taken at a local labcorp near me. Have you ever heard of them ? The 4th gen test should be the same regardless of who places the order, right ? I guess this is the anxiety in me starting to question the accuracy of the test.

H. Hunter Handsfield, MD

22 months ago

Not only is one in a thousand a low risk, but it interacts with the other low risk elements. The chance you have HIV is under one chance in millions, zero for all practical purposes. Re-read my comment above it you still don't get it. I also pointed out that in the presence of a negative HIV test, it is impossible that your symptoms are caused by HIV. And no, I have never heard of anyone testing negative at 1 months and positive later. In theory it can happen, but never has in my experience. I definitely do not recommend any further STD testing.

STDcheck.com is one of many online aggregators for STD/HIV testing. Their performance is irrlevant; what matter is the performance of the labs with which they contract for services. And as far as I know, those labs are uniformly reliable. The HIV AgAb (4gh gen) tests are identical in any lab that does them: worldwide, all labs use the same companies, reagents and equipment.

Thanks for your opening comments of pleasure and support. Now please honor that respect by re-read my replies above, with careful concentration. Sorry if this sounds condescending, but they make it clear you cannot possibly have HIV. Believe it and move on! (Maybe it will also help to know that in the 20 years of this and our preceding forum, with thousands of questions from users concerned about a possible HIV exposure, not one has yet reported that they eventually tested positive. Given the inherently low risk of this situation, you undoubtedly will not be the first!)

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22 months ago

Good afternoon Dr.H.

I do appreciate your comments and respect them. As like most, these questions are driven from fear and uncertainty. I do understand that things are in my favor. By assuming I am infected would mean that: the partner was positive, I am in the 1%-2% to get infected, I am also in the 10%-20% to have PEP fail and also in the 5%-10% that test positive after four (4) weeks. When I write it down, it does seem like I shouldn't be worried.

Not to keep repeating myself but my main area of concern are the symptoms that appeared weeks after PEP completion. Yesterday I did not want to mention but I had a small lump in my armpit and I ignored it. Today it is slightly larger (around pea size) and hurts with certain movements. I am assuming it is my lymph node. If it is, I know it can be caused by different things but that plus the "malaise" feeling and throat are after PEP. The onset of symptoms after PEP is what has me worried.

Isn't the reason of waiting 4-6 weeks after PEP is for possible scenarios like this ? If I am missing something regarding that, please let me know.

For the record, tomorrow is day 38 after PEP.

H. Hunter Handsfield, MD

22 months ago

*Sigh*

You continue to overstate the risks. You were nowhere near 1-2% likely to be infected, and the chance that an HIV test would be falsely negative 4 weeks after completing PEP probably is around 1%, not 5-10%. (Where did THAT come from???) Your only accurate statement is that PEP started at 48 hours probably fails around 10-20% of the time.

I'm entirely aware you are concerned by your later symptoms. I continue to be confident you don't have HIV and that your concluding test results will be negative.

That completes the two follow-up exchanges included with each question and so ends this thread. If you remain uncertain or anxious about it while you wait out the last week until final testing, I suggest you go back and carefully re-read this entire thread. I do hope the discussion has been helpful. Best wishes and stay safe.

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