I'll answer your questions, but here is what I would consider my most important advice:  Had you asked before starting, I would have strongly recommended against anti-HIV PEP in this situation. Given the likelihood any female CSW is likely to have HIV, the transmission risk with unprotected sex, and the effectiveness of condoms, the likelihood you would have acquired HIV is well under one chance in many million. By taking PEP, you will not know for sure if you acquired HIV until at least 6 weeks from now (about 2 weeks after your last PEP dose); and some experts advise waiting even longer. Without PEP you would be able to know 11 days after the event -- now that you've probably taken a couple of doses, perhaps about 2 weeks. Are you willing and conformable not having sex with your wife for nearly two months? And telling her why?

There are no precise data on time to reliable testing after PEP. As indicated above, without it an HIV RNA PCR test would be conclusive 11 days after exposure. Assuming you complete 4 weeks treatment, the earliest possible testing is 11 days after your last dose -- but most experts believe it could take longer and probably would advise a minimum of 2 weeks after the last dose. Even with that negative result, many would advise additional testing over the next 2-4 weeks, with repeat RNA PCR or (our preference) an AgAb (4th generation) blood test 4-6 weeks after the last dose.

Probably just a day or two of PEP would make little difference -- as noted above, an RNA/PCR would probably be conclusive in about 2 weeks.

Another option is to contact your CSW partner, if you are able to, and offer to pay for her to have a new HIV test. If negative, you could stop PEP and not even worry about testing for HIV.

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

HHH, MD

If your CSW partner tests negative, you have no worries, even if she were exposed recently. Recently exposed persons whose HIV tests are not yet positive cannot transmit the virus.---
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