[Question #13410] Follow up to [Question #13319]

1 months ago

Hi Doctors

Thanks in advance for your inputs. Since the last thread noted in the subject line, I have done a full STI panel including HIV 4th gen and RNA PCR at 12.6 weeks post exposure and 8.4 weeks post the last drug of PEP. All negative. My questions are:

1. I believe this now meet the CDC guidelines, can be 100% certain that I did not catch anything from the said exposure?

2. I saw that the prior CDC guideline was to repeat test at 6 month post exposure. How confident are you in their change in assessment that seroconversion post PEP would have happened pre the 12 weeks post exposure mark?

3. I continue to have a foliculitis, took 2 weeks of doxycyline, it helped a bit but some pimples are still there. Could this be another STI? Syphilis test was negative at 12 weeks (ab igg). Dermatologist did a biopsy and waiting results.

4. ~2 weeks before the exposure I laid out in my prior question, I had insertive vaginal exposure to the same woman. It was protected, except for maybe <1 min which is why I did not take PEP after it. In case I had caught anything from her, would the fact that I took PEP 2 weeks later delay my seroconversion beyond my current timeline (ie 14.4 weeks post first exposure, 12.6 weeks post second exposure - which is the time I last had negative hiv gen 4 and pcr rna)?

Edward W. Hook M.D.

1 months ago

Straight to your follow-ups

1. I believe this now meet the CDC guidelines, can be 100% certain that I did not catch anything from the said exposure?

Yes, these results absolutely prove that you did not acquire HIV from your encounter of concern

I am confident, particularly with not only your 4th generation test but your HIV RNA PCR test as well

Folliculitis is a chronic dermatologic problem for some persons. Believe your tests. The biopsy will show something other than an STI.

As I said above, your results are conclusive and should be believed. I'm not sure why you are having such a hard time moving forward.

EWH

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1 months ago

Thank you Doctor for your quick reply. Two follow up questions:

1. If PEP ‘resets the counter’ from an exposure count perspective (which is why some guidance is to test 4-6 weeks after last drug), why would the guidance not be to wait for 12 weeks post last drug of PEP instead of 12 weeks post exposure?

2. I have read online about weird cases of co infection hep c and hiv and the fact that it delayed positive test results. I am not sure how credible this is. Would you agree that I am far along in the testing timeline that if I was co infected, one or both tests would have been positive? The hep c test I did was a serological ab test (as opposed to PCR)

Edward W. Hook M.D.

1 months ago

The data on follow up after completion of PEP are limited because failures are rare. We are not aware of persons with negative tests 4-6 weeks after the last dose of PEP who went on to develop positive tests.

Please don’t look for information on the internet. It’s full of misinformation and it’s hard to sort out what’s true and what’s not

One follow up remaining. EWH

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1 months ago

Thanks Doctor. Could you keep the thread open? Would love to have the opportunity to use my 3rd question once the biopsy results come out (if needed).

Edward W. Hook M.D.

1 months ago

I will leave the thread open until your next post, nomatter what the content. Please do not abuse this favor with further questions on other topics. EWH---

1 months ago

Thank you Dr Hook for very kindly agreeing to keep this thread on.

The result of the biopsy came back as suppurative granulomatous folliculitis, with no fungal, herpetic or syphilis detected. Dermatologist concluded the cause to be bacterial and prescribed longer doxycycline and topical lotion.

1 months ago

What’s still not sitting well with me is timeline to conclusive testing post pep. While you’ve noted that you have never seen a negative test at 6 weeks post pep become positive later, the CDC does acknowledge it happened and is rare. They argue that they’re not sure of the cause (pep failure or additional high risk exposure post 12 weeks), but suspect it’s the latter, which is why they changed their guidelines from 24 to 12 weeks. From your experience, when patients turn positive post pep, when do they do so (by test and symptoms)?

1 months ago

Early last week, I started to have symptoms of red throat, inflamed tonsils, mucus on the back of my throat, a small congestion, and pain on the right of the neck. No fever, no body aches, but slight feeling of chills and night sweats. Went to the doctor who thought it was a viral infection due to lack of Pus / white spots on the throat. I also got tested with Gen 4 and RNA PCR and both were negative (at 12 weeks post pep, 16 weeks post second exposure, 18 weeks post first exposure). Can I be absolutely certain that this is not related to the encounter of concern? Can you confirm I am good to stop testing?

Edward W. Hook M.D.

1 months ago

CDC and its recommendations are conservative because philosophically they take the stance that they cannot afford to be wrong. Thus they never say never. As I have already indicated I have never seen nor heard of someone who has gone on to be proven to have acquired a positive 4th generation HIV test more than six weeks Following an exposure. The negative HIV RNA PCR provides further proof. Typically, when persons fail PEP, tests are positive within 30 days or certainly six weeks of completing their course of therapy. I am confident that you did not acquire HIV from the exposure that you described and urge you to stop testing and move on.

This thread will be closed shortly. EWH.

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