[Question #4210] HIV testing with symptoms

31 months ago
This question is a follow up to #4061. Facts:  Day 10 after exposure, experienced headache/sore throat and obtained HIV duo test--- Negative. Throughout 28 day course of PEP, experienced near constant headache, and intermittent sore throat. Upon completion of PEP at 28 days, per Dr orders, performed HIV duo test and it was Negative. Two days PEP completion, sore throat became more severe and ears ached. No measurable fever. Went to urgent care 5 days after completion of PEP. Urgent care Dr believes this is a bacterial infection and prescribed antibiotics. Six days after PEP completion, went to a clinic and obtained Alere Rapid HIV blood prick test- Negative. Oral Chlamydia and Gonorhea tests are pending. 

Question:
 I understand that the risk of HIV is extremely unlikely given the nature of exposure based on our previous encounters. However, if these symptoms described above were due to ARS,  how likely would it be for the three tests above to have detected it? I greatly appreciate your assessments.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
31 months ago
Welcome back to the forum, but sorry you found it necessary. I reviewed your previous discussion with Dr. Hook and agree with all he said.

Presumably you are concerned that your symptoms could be due to HIV. But truly no worries on that score. First, you were at minimal if any risk for HIV from the events described in the other thread; PEP is highly effective in preventing HIV; and if somehow PEP were not effective, there is no way symptoms of HIV could be present while taking it or start only a couple of days after stopping treatment.

You should follow the advice of the doctor who presribed PEP about follow-up HIV tesiing. If somehow I were in your situation, I would not have any more testing at all. But official advice is that after PEP, a final HIV test be done at 3 months, and some experts say 6 months. That's because when PEP fails, it might delay development of positive blood tests. If you have additional tests, remain relaxed as you wait for the results. There is no realistic chance of a positive result. 

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

HHH, MD
---
31 months ago
Thank you for the reply. I think I do not have an adequate understanding of the medication. Are you saying: even if PEP were to fail, it would still prevent the ars symptoms of conversion during treatment and for a few days thereafter? Also, would the testing I did have a realistic although not definitive chance of detecting the virus, if I seroconverted during treatment when I started having intermittent sore throat around day 9 post exposure? Greatly appreciate clarification if you could. And am very thankful you assess the risk as minimal. Thanks for your insights.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
31 months ago
"even if PEP were to fail, it would still prevent the ars symptoms of conversion during treatment and for a few days thereafter?"  Correct.

I have never heard of anyone developing a positive HIV test while taking anti-HIV drugs for PEP. Both symptoms (if there were any symptoms at all) and positive blood test would be delayed until at least 1-2 weeks (maybe even several weeks) after the last dose of drug.

HIV is extremely unlikely to be the cause of "intermittent sore throat".
---
---
31 months ago
Thank you. Last clarifications. 1. Is it three months since completion of pep or from date of potential exposure? In my previous post Dr hook stated six weeks post pep would be very indicative (which is almost three months since potential exposure). Im not looking for certainty in an uncertain world, but just want to make sure I know when testing is even valuable. 
2. If after 2weeks post pep, I would have symptoms of ARS, would it be safe to say an HIV test at such time would detect it?  Thank you again for all of the education. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
31 months ago
1) Precise data do not exist on potential delay in window period in the event that PEP fails to prevent HIV. That's why you'll find differing advice from equally qualified experts, anywhere from 6 weeks to 6 months. My closest HIV expert colleagues usually advise 6 months, but they acknowledge that 3 months probably is sufficient.

2) If symptoms are due to HIV, the AgAb blood tests are always positive within a few days after onset of symptoms. 2 weeks after PEP (or a few days after onset of symptoms) would be OK. However, that doesn't mean you should be tested for just any symptom. If all symptoms in combination suggest HIV (e.g. sore throat, enlarged lymph nodes, fever, and skin rash), then testing would make sense. Otherwise you'll just need to wait.

This is one of the downsides to PEP, especially for anxious persons at low risk who probably didn't need PEP to begin with. It seriously prolongs the time to conclusive testing and therefore the duration of ongoing anxiety. It's something everyone should consider before starting PEP, especially for low risk exposures.

That concludes this thread. I hope the two discussions have been helpful. Repeated questions on the same topic are discouraged; let's make this your last one on this exposure, PEP, and HIV testing. Thanks. 
---