[Question #11736] 11366 follow up

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12 months ago
Hi Doctor,
Following up with my friend's test result.
He took 33 pep doses, he was given 3 at POC and got a 30pill pack at follow up.

He did an HIV-1 antigen and HIV 1, 2 antibody at 45d after last pep dose. Lab does not specify if 3rd or 4th gen, but I guess ag means it is 4th. Result seems to have come in a couple of hours as per collection and validation dates, with a Cobas 8000 equipment.

Result was non reactive.

Can be consider that test conclusive?
VDRL was also part of lab test package, neg. Is this conclusive too?

He was thinking on finally putting this back with a PCR viral load test. Would you advise against it?

Were I to have any contact with him, could I do it no risk? 

Finally, if I were to engage in unprotected intercouse, what risks would I face given these results and: I am VPH vaccinated, HSV is not a problem since we have had skin to skin contact multiple times already, hep vaccinated (be once got a positive ab  test but follow up mentioned it was due to vaccine), and a potential bacterial g/c. I have never engaged in this activities, nor am planning to, but given the trust it is not something I can rule out 100%.
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12 months ago
We also engaged in unprotected oral today, given his results. I guess this is all fine as well, with only risk being g/c right ?
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H. Hunter Handsfield, MD
12 months ago
Welcome back to the forum. In preparing to reply, I looked back at your previous question. Directly to your questions:

Your friend's negative test result 6 weeks after completing PEP were conclusive:  he does not have HIV. I see no reason to also have an RNA (viral load) test. (He was not at risk anyway and really didn't need the PEP. As discussed last time, sex with an HIV infected person with undetectable viral load is entirely safe.)

If you were to have sex with this person, you would not be at risk for HIV. As for other STIs, of course your risk depends on what infections your friend might or might not have. That you have had skin-skin contact and that you have not acquired HSV does not prove you are not at risk. It's good to know you have been vaccinated against HPV, which of course reduces your risk. You are not at risk for hepatitis B. Whether you could catch gonorrhea, chlamydia or syphilis of course depends on whether he is having sex with other partners. Even if he does, you will still be at low risk if there is no penetrating sex (oral or anal sex). Still, you should keep condoms handy in case temptation results in having such exposures with him.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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12 months ago
Thanks doxtor
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12 months ago
Thanks doctor,

I definitely think on having unprotected oral sex with him, as per my comment I have already done yesterday, and I anticipate keeping on. 

We have previously (before this episode) engaged in protected anal both ways, and would like to do so again.

I know he has not had any sexual activity since all this situation and I wonder if we can get back to those activities. 

For bacterial, I test every 3 m for g/c throat and genital as he does. And VLDR was neg. I also understand the risks on gono and chlam and know given these practices they shouldnt represent a high risk for my health if I ever catch them and test in a schedule.

Given all this knowledge, is there anything to worry about if I engage oral and protected anal for a couple weeks while I am visiting him?
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12 months ago
Finally, forgot to mention, given your reply, my friend has decided to not take a PCR and just leave this behind.
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12 months ago
Apologies for the several replies, my bad.
But I just realized I don't know how to count, test was at 7.5 w, 52 days, not 45. I know this is irrelevant, but almost 8 weeks is actually eve more than we needed for reassurance, correct?
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H. Hunter Handsfield, MD
12 months ago
"is there anything to worry about if I engage oral and protected anal for a couple weeks while I am visiting him?" Given the test results you know about and your intent to keep testing every 3 months or so, probably you'll be quite safe. But of course it depends a lot on whether your partner is likely to continue to have other partners from time to time, which I cannot judge. You know him and I don't!---