[Question #13596] Testing after PEP

Avatar photo
1 months ago
Hello. I started PEP 9/29 5 hrs after exposure. Exposure was male to female (unk status) and I’m male. It was vaginal. I finished pep and didn’t miss a dose. Yesterday I took a 4th gen test at 4 weeks after PEP. It was negative. I also took an rna test but still waiting for results. If these two test are negative can I stop worrying about getting hiv so much?  I take skyrizi for Crohn’s disease. Pls help me answer this. I’m sorting sick. 
Avatar photo
Edward W. Hook M.D.
1 months ago
Welcome to our Forum and thanks for your questions.  I’ll be glad to comment.

The encounter you described was very low risk for HIV or other STIs.  Most women do not have HIV and, on average HIV is acquired less than once in 2000 exposures to infected untreated persons.  Your use of PEP, while probably not necessary, lowered any risk still further.  Your test results prove that you were not infected and when you get your PCR results which I’m sure will also be negative, there will be no way that you were infected from the encounter you described.  Your Crohn’s disease therapy does not change this fact.

I hope that the information I’ve provided is helpful.  There is no need for further testing.  It’s time to move forward without concern.  EWH
---
Avatar photo
1 months ago
Thank you Dr!  This is so reassuring. If you don’t mind I have a follow up question. Not because I don’t trust your answer but because my mind is spiraling into 1k what iffs and I’m trying to feel it back in and there is so much info out there in the web that’s all over the place. 
So what you are saying is that while the CDC says 6 weeks after PEP 4th gen negative is confirmatory, in my situation with my exposure , with the completed PEP, I can move on with the negative test at 4 weeks. 

Does this mean if PEP had failed it would have been seen by this time and the test would have picked it up… IF I was even really exposed? And the rna test would pick it up even sooner after PEP? I only ask this because there is a lot of info out there about PEP delaying window times, sero conversion , etc etc. much more than any non-expert could even begin to understand. And don’t get me started with chatGPT…
Avatar photo
Edward W. Hook M.D.
1 months ago
We spend much of our time on this forum, trying to correct the all too common misinformation found on the Internet. ChatGPT is a useful tool however because it searches the entire Internet some of the information it provides is fueled by an incorrect statements already there.

There are limited data on the optimal time to follow up with HIV testing after completion of PEP because failures are quite rare. PCR tests become positive weeks before fourth generation tests. At four weeks after PEP completion virtually all persons with recently acquired. HIV would have developed a positive test. PCR tests would be positive anytime more than 11 days following completion of PEP.  EWH---
Avatar photo
1 months ago
Hello Dr Hook. I just wanted to let you know that as you said, the RNA test came back normal. Thank you so much for your support and pls know I really appreciate it. 
Avatar photo
Edward W. Hook M.D.
1 months ago
Thanks for the follow up information.  You now have proof that you did not acquire HIV.  Well closed the thread now.  Take care.  EWH---