Hello, I am 30 years old, gay, in an exclusive relationship for a year. My BF is 35, has been diagnosed HIV+ 2-3 years ago. He had an uncommonly low viral load when he got tested positive and started right away ART (Tivicay + Descovy). He’s become undetectable 3 months after starting ART and his doctor, which is an expert in HIV in our country, checks over him every 6 months now. We've been well informed about U=U, but as I am hypochondriac and condom isn’t pleasant on the long run, I chose to take PreP (Truvada) on a daily basis. We both always had an excellent adherence to our meds, like over 95% for sure. We are very aware we can't mess up with that.

Now, I am stressed out because of 2 symptoms I got lately : almost 4 weeks ago, I had a rash on my skin, it was like a pink orange peel and was itchy, it last 3-4 hours and vanished after taking a Benadryl. Maybe a food allergy ? A week later, I had a lymph node that got swollen under my ear (it's still there, but a little smaller). I had my 3-months PreP check-up this morning and should get the results by tomorrow. Meanwhile, I had the following questions :

1. Since I am on PreP, what are the differences with time window and accuracy of 4^th gen tests ?

2. Should I fear blips and viral rebounds ? I read Tivicay was less likely to let HIV develop some kind of resistance. My boyfriend never forgets to take his pills everyday at the same time, so what are the odds that after 2-3 years he experiences a rebound ?

3. I read a lot about PreP and it's sometimes confusing. I read PreP was reducing by 92% the odds of getting HIV, but only a handful of seroconversion cases have been reported, so why experts can't say it's +99% effective ? Is 92% a really conservative number to prevent any data gap ? And is PreP a good backup plan in case of any blips or viral rebound on my bf's end ?

Thanks !

Hello Dr. and thanks for taking the time to reassure me with your knowledge on this very complex topic. I indeed received the results this morning and I am still HIV-, which is obviously very relieving. I still don’t know why I’ve been having this lymph node quite inflamed under the ear for 3 weeks now, but I’ll let my family care Doctor take the lead over this to get sure nothing’s wrong with something else.

That being said, I won’t do like much people seems to do here and re-ask the same questions in loop to find some unnecessary comfort. I learnt over time that asking a doctor to ease an exaggerated anxiety issue with diseases is always very temporary. I must focus on a real long-term solution based on changing my own mindset. If you don’t mind, I would only like to use this topic to give you some space (a quick word) on how people can deal with hypochondriac issues, since it seems to be an overwhelming and common problem on this forum, but also in the real life, especially when it comes to STIs.

I am myself trying to stop googling my symptoms, because people often land on incurable or dangerous diseases like cancers or HIV and keep sticking on the very worst of what they read. And they become mentally fragile, which is a kind of a real and unpleasant disease that brings suffering. And this is a huge struggle/challenge for doctors. Cherry-picking symptoms is really insane, but still hard to manage for a lot of people. I am personally in the procedure of finding a therapist that could help me dealing with my anxiety with HIV and other diseases. I have been told to look at a CBT (Cognitive behavioral therapy) by my Doctor, which seems great despite the cost. Meanwhile, if you have any other suggestions or less costly ways to work on that issue, especially for people here that aren’t lucky as me ( I have great insurances, living in Canada with a great job/salary), I think this would be warmly welcomed by the community here.

Finally, I really appreciate you took the time to respond my questions with respect and the fact that you weighted every words is meaningful to me. Good luck for the next and thanks for sharing your experience and knowledge.

* Sorry for my English, I am a French speaker and learnt English over the last few years.

-A