[Question #11279] Exposures overlap and Pep concern ( "late Pep") #11266

15 months ago

Dear experts Dr Hook & Dr Hunter. Appolgies for feeling the need to ask a follow up question as I know you share this forum. If possible could I ask some questions regarding symptoms after my first exposure Oct-22-2023 and 2nd exposure Nov-26-2023 when Pep was initiated( 16 doses) Regarding my first exposure Oct-22-2023 about 10 days post exposure= mouth ulcers/ low grade fever/ stiff neck/ spleen/dry mouth/ arthralgia/ headaches/ myalgia/ sharp shooting & burning pains in hands and feet/ neck & scalp rash/ extreme gastritis pain and internal fever feeling. As I mentioned I tested negative a few times up to day 35 post exposure Nov-26-2023 via 4th generation for Hiv 1 & 2 and was immediately placed on Pep Nov-26-2023 for my second exposure. ( 16 doses & discontinued) During the first half of Pep symptoms were still present but milder the worst was round near the end & when I discontinued Pep. A week or 2 after Pep discontinuation I started feeling quite ill with viremia symptoms...and complete loss of appetite that carried on for quite some time...also noticed some eruptive cherry hemangiomas on my body abdominal pain etc. As I mentioned I tested negative 33 days & 60 days post Pep via 4th gen lab & day 124 rapid finger prick antibody & day 138 via rapid finger prick antibody for Hiv1 & Hiv2 negative. Currently the abdominal pains are still present but I feel like my esophagus is tender...and recently started getting lung pain spasms and chest pains. I know my concern is delayed seroconversion during the acute phase while I was still busy seroconverting when I started Pep? Aspecialy because Hiv2 can have a lower viral load and antibody response and window period. Please excuse me if this post is filled with anxiety I hope you understand. May I possibly ask some questions?

Kind regards

Edward W. Hook M.D.

15 months ago

I'm sorry you continue to worry and have returned with these repetitive questions. Let me reiterate two points I made in our earlier interaction:

1. "When symptoms are due to HIV, tests are always positive and remain positive from then onward." - direct quote from our earlier interaction.

2. I'll state this more strongly than I did earlier- the idea of "delayed seroconversion" is an internet based myth. In persons who have taken PEP such as you did, IF a test was going to become positive, and they VERY RARELY do, the tests would be positive within 6 weeks after completion of PEP. I am unaware of ANY circumstances in which the small proportion of persons who failed PEP took longer to develop positive 4th generation tests.

THUS, if your "viremia symptoms", tender esophagus or lung /chest pains were due to HIV, your tests at 60, 124, and 138 would have been positive. Symptoms are caused by the present of HIV antibodies and virus, both of which are regularly detected by tests. This would be true irrespective of whether you had HIV-1 or HIV-2. Further, esophageal tenderness and lung/chest pains are NOT symptoms of recently acquired HIB, including HIV-2.

I urge you to do yourself a favor and stay off the internet. My sense is that you are being misled by incorrect statements made there. Instead, see a doctor who can help you sort out what may be causing the symptoms you are experiencing.

I have said this out of concern for you, nothing more. You need to put your unwarranted concerns about HIV aside and move forward. EWH

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15 months ago

Greetings Dr Hook. Apologies for all the questions regarding my overlapping exposures and Pep. Please don't take it as a disrespect to your knowledge or expertise. Please excuse me.....this comes out of a place of concern more than anything else. Some reputable sites state that if a person presents with possible acute ars symptoms they may or my not test antibody positive due to the window period and unique immune system response to the virus and that individuals seronverting do so at different times. This got me worried that I was still seronverting after my 1st exposure Oct-22-2023 and started Pep for my 2nd exposure Nov-26-2023 ( 16 doses) Some reputable sites and Physicians stated that late Pep or Pep initiated in the acute phase could affect test results and might cause delayed seroconversion.

1. If I was truly exposed on Oct-22-2023 1st exp & started Pep for 2nd exp Nov-26-2023 delayed seroconversion for Hiv1 & Hiv2 antibodies will not be a concern and would still test positive on my recent tests regardless?

2. Could it be possible for early intervention with Arvs ( Pep) to cause iris or unmasking iris during the possible acute phase? For TB, CMV or kaposi's sarcoma HHV8?

2.Is it possible to have kaposi's sarcoma on the inside of the digestive tract and lungs without lesions on the outside of the skin?

3. Does my 4th generation tests & rapid tests done after the 1st exp Oct-22-2023 & 2nd exp Nov-26-2023 regardless of Pep prove that Hiv1 or Hiv2 antibodies would have been positive by know?

4. If I was truly exposed on Oct-22-2023 1st exp infection would of been established and regardless of ( 16 doses of Pep for 2nd exp Nov-26-2023 I would still test antibody positive for Hiv1 or Hiv2? Kind regards & thank you. From South Africa

Edward W. Hook M.D.

15 months ago

I'm not sure what you mean by "reputable sites". If you refer to the internet, you should be more cautious. Much of what is there, despite sounding reputable, is incorrect for a variety of reason including that statements a misinterpreted or taken out of context, are out of date, are overly conservation or are just plain wrong. Your follow-ups are largely repetitive. Repeating your questions will not change the answers.

Correct. Any theoretical delay would have been measured in days or perhaps a week or two. You are now months out from completing PEP. Your results are entirely valid and should be believed. Repeating the tests is a waste of time and money- the results are not going to change!!!

2. Could it be possible for early intervention with Arvs ( Pep) to cause iris or unmasking iris during the possible acute phase? For TB, CMV or kaposi's sarcoma HHV8?

No. IRIS always occurs in persons with positive tests and proven HIV.

2.Is it possible to have kaposi's sarcoma on the inside of the digestive tract and lungs without lesions on the outside of the skin?

Yes, but such persons will always have positive tests for HIV.

3. Does my 4th generation tests & rapid tests done after the 1st exp Oct-22-2023 & 2nd exp Nov-26-2023 regardless of Pep prove that Hiv1 or Hiv2 antibodies would have been positive by know?

Yes, see my response to your question number 1.

Repetitive- see earlier answers.

You have one follow-up remaining as part of this thread. After that the thread will be closed. Any further questions are likely to be deleted without a response and without return of your posting fee. You need to move on. EWH

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15 months ago

Greetings Dr Hook. Thank you for the response and awnsers to my concerns mentioned. I'm just concerned as to why I felt so terrible after the exposures and the Pep in-between. In the "acute" phase I even had hairloss and after the Pep the extreme viremia symptoms that left buldging ridges on my finger nails and the severe loss of appetite scared me also with the internal fevers and chills I also have a white coated hairy tongue and extreme fatigue off balance etc. Could any immune deficiency or underlying conditions or illnesses or disease affect me from not being able to produce Hiv1 or Hiv2 antibodies like staging cancer etc? ( 4th gen or rapid testing) I tested negative for all other stds twice! Ebv/ Cmv/ Coxsackie all past infections. Reactivation possible? I'm just very afraid as to what's going on with my body. I have an appointment with a internal Physician soon. Spent thousands thus far. The contact partner tested negative 63 days post contact via 4th generation Neg for Hiv1 & Hiv2 antibodies but what concerns me is that Hiv 2 has a slightly longer window period due to the absence of the p24 antigen for Hiv1 detection. I believe the Hiv2 window period could be 12 weeks and beyond as the 4th generation acts like a 3rd generation test for Hiv2 antibodies. I'm in fear....worried and confused. I know my body and I know something terrible is wrong. I lost hope....but thank you for all the awnsers to my questions.

Kind regards

From South Africa

Edward W. Hook M.D.

15 months ago

Either you have not read my earlier replies, do not understand them, or are ignoring them. Everything you say above is repetitive. The results are not going to change. Partners who test negative for HIV 63 days after an exposure cannot have transmitted HIV-1 or HIV-2. You are misinterpreting the HIV-2 window- your results are conclusive.

I do not know what is causing your symptoms but I can assure you, based on all of the testing you (and your partner) have done, that HIV-1 or HIV-2 is NOT The cause. Your insistence and repetitive concerns will only delay you finding out what is causing your problems.

This is my final response to you. The thread will now be closed. You need to move on and are having trouble doing this. If you return to the Forum, any further questions will be deleted without a response and without return of your posting fee. This is being done out of concern for you, nothing more. EWH

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