[Question #12252] Stopping PEP
9 months ago
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Hi Doctors,
I had unprotected vaginal sex with two different CSWs in India (Mumbai red light district), so am sure this was riskier than most. Just a few days prior to this, I had a negative RNA test and negative Duo test. I started on PEP (Truvada only) at 17 hours and its been 3 days now. I got both the CSWs tested by Duo and the results came in as non-reactive (one was 0.39 and the other was 0.30). I am still waiting for their RNA test results.
1. Would their negative Duo test results alone allow me to stop PEP? Or would I need negative RNA results to stop?
2. I am only on Truvada (2 medicines) for PEP. Most countries suggest 3 medicine regime. But Australia says 2. So, is this enough for PEP?
1. Would their negative Duo test results alone allow me to stop PEP? Or would I need negative RNA results to stop?
2. I am only on Truvada (2 medicines) for PEP. Most countries suggest 3 medicine regime. But Australia says 2. So, is this enough for PEP?
3. What do the numbers mean in the DUO result (i.e. the 0.30 and 0.40) - does this mean it is high and possible border line? Normally my duo results are below 0.20.
4. I took prophylaxis of 2.5 grams Zithro and 800 mg Cefixime 48 hours after exposure. Is this enough to prevent all bacterial STDs and avoid any testing for the same?
Thanks
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Edward W. Hook M.D.
9 months ago
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Welcome to our forum. You are correct that the rates of HIV in Mumbai are higher than in many other areas. The DUO results are strong evidence that your partners were not infected and did not put you at risk. There remains a theoretical possibility that one or both of them might have been in the so-called window. Between acquisition of infection and the appearance of HIV antigens or antibodies and, while this is rare, if you have PCR test results pending, the safest possible approach would be to wait for those results. While HIV post exposure, prophylaxis typically involves three drugs, without a doubt the Truvada you were taking will dramatically reduce any risk of acquisition of HIV. Thus, in reply to your specific questions.:
1. See above. It is very, very unlikely that your partners had HIV infection but there remains a very small change
2. Also answered above. The Truvada would certainly reduce the already very low chance of acquiring infection.
3. The results of these tests are reported in numerically. Negative is negative. Trying to read into variation in the numbers is a waste of time. The variation is meaningless
4. Yes
I hope this information is helpful. I would encourage you to consider one of the many ways that you might adopt safer sex practices going forward. If there are further questions or any part of my responses or unclear, please feel free to use your up to two follow-ups for clarification. EWH.
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9 months ago
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Dear Dr. Hook,
Thank you for your reply.
I actually just received their negative HIV RNA test results, so all good on that front. I did have some specific follow up questions:
I actually just received their negative HIV RNA test results, so all good on that front. I did have some specific follow up questions:
1. The RNA test is only for HIV 1 and sensitive upto 20 copies per ml performed on a Cobas 5800. Is this lower limit of detection as good as undetectable or does one need to look for even lower thresholds to completely rule out HIV presence? And since it does not test for HIV 2, is that something I should be worried about in India?
2. I'm confused as to why there could be even a small chance. Regardless if the source was in the window period, I was under the assumption that one has to be detectable in order to transmit. So, since the results showed undetectable, wouldn't this mean absolutley no risk and I can stop PEP?
I appreciate the encouragement for safer sex practices in the future. And really, its the alcohol that ends up with poor decision making. So, am going to give that up, and when I'm sober, I always practive safe sex.
Thanks
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Edward W. Hook M.D.
9 months ago
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1. This lower limit is effectively undetectable. HIV-2 is present in India however it would have shown up in your partner's tests.
2. In Medicine there are no absolutes. These PCR results, which were not available at the time of my original reply mean that there was no risk.
EWH
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