[Question #11124] Hiv Ars symptoms / use condom and prep both

16 months ago

Dear doc, 30th jan prep on demand ( 2 doses at 11pm) on 31st Jan protected insertive vaginal & protected oral sex 2 times (16&19 hrs after double dose)

Condom..water test and take picture of it both times 100 % sure no break no slip ...vaginal sex for less than 3-4 min both csw are high end ..after sex....I take 7 doses so 9 tablets( 2 before sex & 7 after from 31st Jan to 6th Feb

11th Feb to 14th I have severe facial pain , on bending , sinus ,no fever

all 6 members of my family have fever , cough , nasal congestion from 12th feb ..flu season in delhi

14th Feb ..my cough starts .

And then on and off fever from 15th Feb night till 18th ..with cough daily with green/ yellow mucus in morning ...heavy sneezing , nasal congestion, water from nose & eyes for 2 days overall fever tiredness for 3 days not so high ( between 99 to 101)..fever gone .on 19th feb...but cough remains in morning with wheezing and pain in chest after cough ...with green phlegm little blood in phlegm 2 times in morning ... Doctor told me it is post viral cough ...amoxillin for 5 days ...no cough after 14 days

1. Do hiv ars symptoms occur after

4 days or Can fever start on 8th day after stopping prep if prep fail? my symptoms not ARS due to sneezing , productive cough , wheezing etc. ?

2. Do my body is fighting with hiv ARS as well as some respiratory infection simultaneously ?

3. Think my risk is 1 in billion due to my condom , prep , vaginal sex etc...i tested on 6th Jan2024 do I need to test for hiv again ?. Do 7 doses better than 2 doses after sex?

4. WHO, Europe , IAS -USA says

cis man ( for vaginal sex) can start with double dose for daily as well as for on demand and continue for 2 doses after last sex ...I think That both daily or on demand are same ... protection near 100%

Edward W. Hook M.D.

16 months ago

Welcome to the Forum. Thanks for your questions. Congratulations on your approach to practicing safe sex- the combination of having taken PrEP on Demand and condom use for all of your exposures make these encounters virtually no risk. Your symptoms of facial pain and other respiratory symptoms are not symptoms of recently acquired HIV.

In response to your specific questions:

1. Do hiv ars symptoms occur after

4 days or Can fever start on 8th day after stopping prep if prep fail? my symptoms not ARS due to sneezing , productive cough , wheezing etc. ?

As mentioned above, these are not symptoms of recently acquired HIV. 4 days is very early for the onset of HIV-related symptoms.

2. Do my body is fighting with hiv ARS as well as some respiratory infection simultaneously ?

This is most unlikely

3. Think my risk is 1 in billion due to my condom , prep , vaginal sex etc...i tested on 6th Jan2024 do I need to test for hiv again ?. Do 7 doses better than 2 doses after sex?

I agree that your risk for HIV is virtually zero. So low it is difficult to provide a number. There are no scientific data to suggest that 7 doses are better than the recommended 2 following sex.

4. WHO, Europe , IAS -USA says

Correct. Your risk for infection is virtually zero

I hope this information is helpful. Please don't worry. EWH

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16 months ago

Thank you doctor for your reply

Sorry for asking more questions just need to clarify few things

1. I want to clarify My symptoms start 11 days after sexual exposure and 4 days after stopping prep and fever start on 8th day after stopping prep and 15 days after sex..................I want to know if prep fails what are the timeline of symptoms of ARS.

2. lots of sneezing ,watery nose and eyes for 2 days during fever also cough with greenish phlegm for at least 10 days ... little pain in throat at that time on one side of throat for one day only may be due to cough.? .I also have wheezing and chest pain after cough .......also my whole family was ill with similar symptoms at that time ..............so I think ( Fever is part of respiratory infection not ars in my case). Do I need to test for Hiv ( medical risk only )?

3. I take prep on demand double dose at exact time when required according to guidelines and took 7 doses after sex ...........so do really prep fail for those people who don't missed doses.

4. A recent study showed it is level of drug in PBMC that matters not in tissues so we can say that prep protects from all sexual exposure ( oral sex etc).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10667095

Zhang L et al. Model-based predictions of protective HIV pre-exposure prophylaxis adherence levels in cisgender women

according to many guidelines( like WHO technical brief 2022) that daily and on demand prep are same for particular sexual exposure for cis man in insertive vaginal sex ? So I can continue with prep on demand and condom no need to switch to daily since my exposure are once a month and fully trust prep on demand if condom fail in vaginal sex ?

16 months ago

Dear Doctor ,

Have you got my questions ?

Edward W. Hook M.D.

16 months ago

Please be patient. The site is not staffed 24/7. These questions are largely repetitive and do not change my assessment

I understood the answer. No change in my response.

Testing is always a personal choice. Your risk for HIV was virtually zero. If testing would make you feel better, you can test. I am confident that if you test, the test will be negative proving that your symptoms are not due to HIV

3. I take prep on demand double dose at exact time when required according to guidelines and took 7 doses after sex ...........so do really prep fail for those people who don't missed doses.

Is this a question? As I said, taking PrEP on demand as you did is close to completely protective

4. A recent study showed it is level of drug in PBMC that matters not in tissues so we can say that prep protects from all sexual exposure ( oral sex etc).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10667095

Zhang L et al. Model-based predictions of protective HIV pre-exposure prophylaxis adherence levels in cisgender women

Of course you continue taking PrEP on demand if you wish. This study had no relevance to your concerns. It shows that persons who do not take PrEP as prescribed and who miss doses may not achieve full protection.

You have one follow-up remaining. EWH

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16 months ago

Dear Doctor ,

Thanks for your reply. Your replies help me lot

I decided not to test right now as my risk is practically zero but will test hiv on my routine test for std

Just need to confirm few statements for future

I read other questions on forum I interpret from your and Dr. Hunter replies

1.Unprotected receipt of oral sex from female CSW is risk free for hiv ..........even blood in her mouth . Even if some risk is there Prep on demand will completely protect me from hiv . Am I right ?

2.Open mouth kissing female CSW is risk free for hiv ...even blood and bleeding gums in both

partners but Even if some risk is there Prep on demand will completely protect me from hiv . Am I right?

3. Condom protected vaginal sex is virtually zero risk ...even if condom break prep on demand will completely protect me from hiv. Am I right ?

4. Now both prep on demand or daily prep starts with double dose as per WHO guidelines...so both are same and equally effective .Am I right ?

5. Condom for all exposure ( oral included) + prep on demand + routine test for std will keep me safe from hiv . Am I right ?

16 months ago

6. Truvada ( I use generic Tenvir EM) remain stable at 40 degree celsius according to Gilead website ........in original container....temperature is high in India . Am I right .? So no worries about temperature .

Thanks again Doctor for your support .

Edward W. Hook M.D.

16 months ago

Final Responses:

1.Unprotected receipt of oral sex from female CSW is risk free for hiv ..........even blood in her mouth . Even if some risk is there Prep on demand will completely protect me from hiv . Am I right ?

Correct, there are no proven cases of HIV which were acquired through receipt of oral sex.

2.Open mouth kissing female CSW is risk free for hiv ...even blood and bleeding gums in both

partners but Even if some risk is there Prep on demand will completely protect me from hiv . Am I right?

Correct

3. Condom protected vaginal sex is virtually zero risk ...even if condom break prep on demand will completely protect me from hiv. Am I right ?

Correct

4. Now both prep on demand or daily prep starts with double dose as per WHO guidelines...so both are same and equally effective .Am I right ?

There are no statistical differences in the effect of daily PrEP and PrEP on demand.

5. Condom for all exposure ( oral included) + prep on demand + routine test for std will keep me safe from hiv . Am I right ?

Correct

I know of no data to contradict the Gilead website.

I applaud your commitment to safe sex. Please remember however that in Medicine there are no absolutes so when I confirm your statements, please realize the on extraordinarily rare occasions things occur by chance that are hard to explain.

End of thread. EWH

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