[Question #11097] Can’t Find Info Anywhere

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17 months ago
Hi Doctors I have been looking and cannot find information anywhere. Here is my situations: in February  I (man) received oral sex from another man and engaged in cottage. The day after I started PEP treatment. However, I foolishly had unprotected sex with my boyfriend while still on my PEP (about 1-3 weeks into taking PEP). Now that pep is over and it has been 6 weeks I got a negative test result. However, I am worried that I could have infected my boyfriend while I was on pep. 

- is is possible that I infected him while I was on PEP, but I am getting a negative test result since the PEP ended up working for me? 

- during the course of pep, does my viral load increase, but then decrease after pep starts working? My regimen was truvada and another pill that starts with R. 
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17 months ago
Typo. The exposure was *frottage and oral. Also the second PEP medicine I took was called ralfegravir. Also to be clear my worry is that I passed hiv to my boyfriend by having unprotected sex with him while I was still taking PEP. 
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Edward W. Hook M.D.
17 months ago
I think that you misunderstand how HIV is transmitted.  Only persons who have HIV can transmit the infection.  There is no evidence that you have HIV.  In fact, the aggregate information is that you are not infected.

1.  Your February encounter was NO risk.  There is no evidence that receipt of oral sex or frottage are risk factors for HIV.
2.  There was no medical or scientific reason for you to take PAP.  That said, when on PEP, you are neither at risk for acquistion of HIV, nor is there any medical or scientific reason to think that you could infection a sexual partner.
3.  Your test results, 6 weeks after completion of PEP, PROVE that you do not have HIV

Given these FACTS, there is no conceivable medical or scientific way that you could have transmitted HIV to a partner.

The situation of a fluctuation viral load that you suggest does not correlate with the biology of HIV

Bottom line, I am not sure why you are worried that you could have transmitted HIV to your regular partner.  This is not a concern.  EWH
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17 months ago
Thank you doctor. My confusion comes from things that I read online that says don’t have unprotected sex while on PEP as you can pass hiv to your partner. Also my boyfriend had really bad flu like symptoms last week. They only lasted a day, so I thought maybe that can be ARS. 

So are you saying that while taking PEP you are unable to transmit hiv? 

I also forgot to mention that in the middle of me taking PEP I took 2 HIV RNA (at day 4 and day 10 of taking pep) tests that were negative. Is it possible that my viral load could have went up after I took those tests, but then quickly went back down by the time I finished PEP and tested 6 weeks after completion of PEP, or does it not work like that? 
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Edward W. Hook M.D.
17 months ago
The internet is not your friend here.  Much of what is there is incorrect, either because it is misinterpreted, out of date, taken out of context, or just plain wrong.  

If a person is taking PEP and the PEP fails, then they could theoretically transmit HIV however persons taking PEP who remain HIV negative/uninfected cannot transmit HIV.  A person must have established infection to transmit HIV.   If your PEP had failed, your HIV RNA PCR tests would have been positive.  The idea that persons who take PEP can have virus transiently circulating with levels going up and down while on PEP is an urban myth.  EWH
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17 months ago
Thank you doctor. A few last questions:
- my boyfriend had body chills, and a fever that only lasted about 4 hours then cleared up. After that he has been having sore throat on and off, and sniffling, stuffy nose on and off for the past few days. He would literally feel fine one day, and the next day the sore throat returns, then leaves again. Is this consistent with ARS?

- has there ever been a case where someone passed hiv while taking pep, but actually never tested positive for hiv themselves? Or is this not possible at all? 
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Edward W. Hook M.D.
17 months ago
The symptoms or the ARS do not come and go.  No one has ever transmitted HIV in the manner you suggest.  you are not going to be the first and, as I said earlier, the encounter you describe did not put you at risk for HIV

Let me also point out that careful scientific studies have shown when at risk persons develop a flu-like illness suggestive of the ARS (not that your partner's illness suggests the ARS), less than 1% of such persons have HIV.  The remainder have influenza, COVID 19, or one of the many, many common viral illnesses that we all get from time to time.  

As you know, we provide up to 3 responses to each client's questions.  This is my 3rd response.  Thus this thread will now be closed.  

I urge you no to worry that you have HIV or that you might have passed it to your partner.  EWH
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