[Question #4122] HIV Symptom Question

84 months ago

Doctors, thanks for your service. Chain of events: Evening July 13^th – safe protected sex with a person who was HIV+ (did not know at the time, miscommunication). I was top. I later learned this person is taking HIV medicine. Morning July 14^th – go to med center, doctor said my chance of getting HIV was almost the same as getting struck by lightning. Gave me HIV test. Negative.

Despite his comforting words/facts, I was decidedly a wreck. The doctor seemed to take pity on me and mentioned PEP treatment but said it likely was not necessary yet still my choice. I decided to do it, anyway. I took the PEP as prescribed daily for the past month. Truvada and Tivicau.

August 13^th – walked 2 hours in humid wet field, bit by many mosquitoes. August 14^th – rash on my chest and shoulders. I thought it was an allergic reaction, maybe West Nile Virus. I did not think anything of it then I read this is could be a symptom of acute HIV.

Obviously, I will get retested and confer with my medical practitioner. But for peace of mind, I am asking your thoughts. I have read the stats and it seems unlikely this is a symptom of HIV, but I’d just like to hear your thoughts. I have no other symptoms (no flu, no swollen glands, etc.). The rash does not itch or hurt. The rash was stronger last night, weaker today but still present. The rash looks like very weak chicken pox.

H. Hunter Handsfield, MD

84 months ago

Welcome to the forum. Thanks for your question.

I understand your concerns and why this was an alarming situation for you, at least initially. However, your doctor was correct about the HIV risk associated with this event: it was zero for all practical purposes. To the point that many regular partners stop using condoms entirely when one person has HIV that is well controlled (no detectable virus in the blood) on HIV treatment. There has never been a proved case of HIV transmission in this circumstance. Nobody can say the risk is zero, but it is exceedingly low. In addition, you used a condom.

So I also would have strongly recommended against PEP, and I'm not sure I would have acceded to your request even if you had pleaded with me. Your risk was that low. Among other things, there is a downside to PEP that you might not have thought about. I hesitate to raise it, for fear of increasing your anxiety: but if PEP doesn't work, it probably prolongs the time to conclusive blood test results. You're going to need to wait 3 months -- or depending on your doctor/clinic's advice, as long as 6 months -- for conclusive testing to know for sure you weren't infected. Without PEP, conclusive testing can be done at 6 weeks, i.e. about 10 days from now.

Finally to your symptoms: Acute HIV never causes rash as the only symptom. Rash occurs in acute infection, but only along with fever, sore throat, enlarged lymph nodes, and other symptoms. Also, HIV rashes are not likely to be limited to the chest and shoulders. Finally, it is virtually impossible to have HIV symptoms while taking PEP drugs. When PEP fails, it delays onset -- but acute HIV symptoms while taking treatment is unheard of.

There's at least a fair chance the rash indeed is an allergic reaction to the PEP drugs. It would be wise to check with the prescribing doctor or clinic -- which you'll need to do in order to discuss timing of follow-up HIV testing.

Bottom line: This isn't HIV and you were at little risk for it. But still a good idea to check back with the prescribing doctor.

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

HHH, MD

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