[Question #11343] Symptoms 6~8 weeks after the completion of 28 days PEP

15 months ago

Dear doctors,

Thank you very much always, and sorry for my broken English.

Here's the background. I had a protected sex with a woman who works in an office as an one night stand here in S. Korea almost 12 weeks ago.

I was a little bit drunken but I remember that I had used condom for the whole penetrative actions during that sex. But after the sex, I had found that the condom had sipped out and had been hanging on the tip of my penis when I had rested in the bed.

After that, I went to an emergency and started the PEP, Truvada + Tivicay for 28 days. I had the first dose 17 hours after the exposure and keep the every doses well. Only I mistook is that I had Aspirin protect(which has aluminium) only one hour after the first dose of the PEP.

45 days after the completion of 28 days PEP(It was 9 days ago), the cold onset. It started with minor irritaion of throat and some sputum and cough. And as day goes by, low grade fever(lower than 37.5 degree Celsius) and not severe muscle pain came.

15 months ago

This cold symptoms subsided 7 days after the first onset. But just 1 day after, the yesterday, my accessory salivary gland in my lower lips swell a little bit and sore throat restarted. But the location of sore throat changed. And today, sore throat has been going bad and I found that my neck lymph node on the same side of sore throat swell alot. But no fever, no muscle pain until now.

I have a test appointment next week.

15 months ago

I have some questions based on my background.

1. If condom slipped or was broken, is there any chance of transmission of HIV?

2. Can having 1 tablet of Aspirin protect 1 hour after the 1st dose of the PEP affect on the efficacy of Truvada?

3. How effective is 28 days PEP started in 17 hours after the exposure?

4. Can my symptoms be ARS or something related to HIV?

H. Hunter Handsfield, MD

15 months ago

Welcome back, but I'm sorry you found it necessary.

In this and a couple of your other questions a few years ago, you clearly misunderstand HIV symptoms. ARS does not include nasal congestion, cough, etc. The "flu like" symptoms you read about as ARS are fever, muscle aches, and headache. ARS also does not cause localized pain, like neck pain. In addition, you had a very low risk exposure that really didn't need PEP anyway.

I'm surprised you don't mention HIV testing. What were your test results after completing PEP? If you haven't been tested, of course you should do that now; it is likely that the negative result will be more reassuring than anything I can say. To your specific questions:

1) Even with entirely unprotected vaginal sex, the risk is about one chance in 2,500 IF the female partner has HIV, and your partner probably did not. And condoms work! Condom breakage (or if it slipped off entirely) of course would make the risk a bit higher, but still near zero. As I said above, if you had asked ahead of time, I would have advised against PEP.

2) No, a bit of aspirin makes absolutely no difference.

3) Very close to 100% effective.

4) Your symptoms do not fit with ARS, not even a little bit. They also started far too late; if you had HIV despite PEP, symptoms would have started within 1-2 weeks of your last PEP dose.

I hope these comments are helpful. Let me know if anything isn't clear --and also let me know your HIV test result(s).

HHH, MD

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15 months ago

Thank you very much for your kind and clear answer.

Actually, I had an appointment for the testing but I couldn't keep the schedule due to long business trip. So I will test in next week.

I want to ask about the onset time of ARS.

In some answers here, I could find some of your comments about the window period after PEP. An in those answers, you said that window period after PEP is normally 6 weeks, but sometimes can go to 3 months after the completion of PEP in conservative perspective.

But you also mentioned that ARS would start in 1~2 weeks after the completion of PEP in the answer to my question. And I remember that you used to say that when ARS really is, the 4th Gen. test always be positive.

For me, these comments seem little bit contradictory. Based on your explanation I mentioned, if ARS start always in 1~2 weeks after the completion, window period after PEP would also be 1~2 weeks.

But you also said that the window period would be 6 weeks to 3 months. Would you explain a little bit more about this?

H. Hunter Handsfield, MD

15 months ago

You're misunderstanding our responses to different questions and situations. We have written nothing about HIV test timing that should be confusing.

Almost all experts advise a 6 week window for testing after the last dose of PEP. And anyway, testing almost always is done earlier than that. The window is the maximum time to a reliably negative results. The large majority of newly infected persons test positive with 2-3 weeks, and normal testing after PEP is several tests over 6 weeks, starting immediately at the end of treatment.

Onset time of ARS symptoms usually is 8-10 days, rarely up to 3 weeks. Never longer. And yes, the blood tests ALWAYS are positive if symptoms are caused by ARS. There's nothing contradictory about any of this. Most people with new HIV never have ARS symptoms. If someone DOES have symptoms and testing is negative, that means the symptoms were caused by something else, not ARS. And of course most people with new HIV infections never have ARS, i.e. no symptoms. In fact, symptoms almost never are useful indicators for whether or not someone has a new HIV infection. Blood tests are only reliable evidence.

Given your sexual history, it is exceedingly likely you have HIV; and your symptoms make no difference. If it has been more than 6 weeks since your last dose of PEP, you should have an HIV AgAb (4th generation) blood test now. You should expect a negative result.

I'll be happy to comment further when you report a test result, but will have nothing more to say until then.

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15 months ago

Thank you, doctor, it is very clear.

"Given your sexual history, it is exceedingly likely you have HIV"

Is this typo?

Other than this, I have no more question, thank you once again.

I will let you know my test result.

H. Hunter Handsfield, MD

15 months ago

Yes, a typo. UNlikely, not likely. I suspect you understood, but sorry for any transient uncertainty.

Thanks for the thanks. There is no point in posting your negative HIV test result and threads are closed after two follow-up comments and replies. But I'll make a deal for you: in the extraordinarily unlikely chance your HIV test is positive and you wish to let us know, we will reimburse that posting fee.

Best wishes and stay safe.

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