[Question #3692] ARS after 2 days? and more

87 months ago

Hi Doctors,

Appreciate this resource.

I had brief unprotected sex (insertive vaginal) - as well as a lot of unprotected oral sex - with a sex worker last Friday night.

To be safe, I started PEP on Saturday. It's easy to get in NYC which is great.

I felt pretty okay but Monday morning, I started feeling a sore throat, chills, and body ache. The chills and aches were bad enough to keep me home the past 3 days. (no rash or enlarged lymph nodes or anything else) Now, Friday, I'm feeling much better.

Most resources say ARS "usually" doesn't start that soon (2-3 days), but some say it can start "in days".

I'm not sure what to believe.

Is it possible it was ARS and the PEP made the symptoms less severe and made them pass quicker?

One more thing - my blood test from the clinic that gave me PEP showed high neutrophils and slightly low lymphocytes. Not sure how that factors in.

I know I'm not thinking too rationally but I'm scared so I wanted to reach out.

Thanks for your help,

H. Hunter Handsfield, MD

87 months ago

Welcome to the forum. Thanks for your your confidence in our services.

Once in a while we get questions that can be accurately answered based only on the title chosen by the user, without reading further. As I write this sentence, I'm doing that -- I haven't yet read beyond the title: No, it is not possible for ARS to start to cause symptoms 2 days after exposure. 7 days is the minimum and it's usually more like 10 days.

Now I have read the rest. Guess what? Wise move to seek PEP in this situation -- at least some female sex workers there have very high risks of HIV and PEP probably was wise. I am unaware of data that ARS symptoms can develop while on PEP, but the important thing is that they for sure started too soon. I would be far more suspicious that you caught a garden variety respiratory virus, possibly (but not necessarily) from the sex worker. Obviously if close enough for sex and for HIV risk, you were plenty close enough to catch a cold, influenza, etc.

If you were feeling fine at the time you were seen and had a complete blood count, I think you can completely disregard the abnormal neutrophil and lymphocyte counts. I imagine they did that not because they expected something to show up, but to help assure you didn't have a medical condition that might affect the effectiveness of PEP. Anyway, mild abnormalities like these are extremely common and usually meaningless. (Of course this depends in part on the exact numbers. If you'd like to let me know the exact counts I might have more to say about them.)

The other thing to remember is that even without PEP, and even if your partner had HIV and was not on treatment for it, the average risk for HIV transmission during a single episode of unprotected vaginal sex is around 1 in 2,500. In other words, it would take daily exposures like this for several years to add up to a high risk of being infected. (The oral sex part was zero risk for practical purposes.)

So regardless of your symptoms, your the chance you have HIV is virtually zero. I really wouldn't worry about it, and would recommend you continue the PEP for the duration prescribed; and follow the clinic's advice about timing of follow-up HIV tests as the next several weeks go by.

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

HHH, MD

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87 months ago

Hi Dr. H!

Thanks so much for the speedy reply.

Life is so weird. I work in finance (in a design/creative capacity, not a money capacity), and this morning a colleague came to me to talk about the currency in Argentina, whose initials are ARS. I kid you not. I'm superstitious and that alone would have told me it was a sign from God that I had a problem - had you not already responded!

So a few more things:

1. I didn't mention I fingered her a bunch and my nails were long and there was some blood. I am assuming that's not a concern because I had no real cuts etc.

2. In fact, I already had started to feel a little ill when they did my bloodwork (again, this was all within 48-60 hours post-exposure). So I was wondering if that all kind of tied it together - that the high WBC was in response to whatever I *did* have.

3. Yes, they def did the bloodwork as standard protocol I'm quite sure.

My WBC value was 12.2 (Std 4.5-11.0) (I assume Std means standard, not STD. Again, these initialisms!)

Neutrophil % was 84.7% (Std 40-78)

Neutrophil # was 10.4 (std 1.9-8)

Lymphocyte % was 7.4% (Std 15-50)

Lymphocyte # was 0.9 (Std 1-4.5)

I think that's all the information I could possibly report.

Thanks so much again,

87 months ago

oh real quick on the timeline - they gave me 3 doses of PEP over the weekend without a consultation. Then I had the consult on Monday. That's why I had already started PEP before I felt ill on Monday and before they did my bloodwork.

87 months ago

shoot sorry one more thing - you think it still might have been respiratory even though I didn't have any coughing or congestion or sneezing or anything? I sweat that's it now.

H. Hunter Handsfield, MD

87 months ago

You mentioned sore throat, which counts as respiratory. Your blood count is entirely consistent with an acute infection, probably a mild one -- i.e. also fits with an acute respiratory or other viral infection.

Fingering has never been known to transmit HIV, regardless of cuts and nicks on the fingers. In theory it probably could occur, but with no known or reported cases among the millions of infected people worldwide in the past 4 decades, I think you'll agree the odds are miniscule. And we still have the timing issue.

You'll do best to keep in touch with the clinic where the PEP was prescribed, and/or whichever medical provider will be following and supervising your care. But let me know if you still have any further questions/comments (one more max before the thread is closed).

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87 months ago

Hi Dr. Handsfield,

I do have one more question here. A two-parter.

1. I was diagnosed with HSV-2 8 years ago. I've seen you say that roughly doubles the chance of HIV transmission, which would be around 1-1,000 so I still feel pretty 'good' about that. Is your ballpark estimate still around that number?

2. Would HSV-2 affect the efficacy of PEP at all? I've also read HIV reproduces faster when HSV is present.

I think that's literally all I have. And I know it's my last allowable question anyway.

Thanks so much again,

H. Hunter Handsfield, MD

87 months ago

1) Correct. "Double risk" sounds important, and in a way it is: in any given large population, the frequency of new HIV will be twice as high in people with HSV2, assuming similar sexual behaviors and other risks. OTOH, if the risk of any particular exposure is, as you point out, 1 chance in 2,000, a rise in that risk to 1 in 1,000 doesn't seem so alarming. Even less so for a risk of say, 1 in a million, a common scenario on this forum.

2) There are no infections, health conditions, or medications known to have a significant effect on the effectiveness of PEP, or any other form of HIV therapy.

Thanks for the thanks. I'm glad to have helped.!

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