I had two exposures in the same week, only four days away.
I was on Triumeq PEP(not Truvada PrEP) at 40 hours after the second exposure, but I didn't complete the full 28-day course. I took 7 Triumeq in six days (I took it TWICE on the third day to adjust medication timing, so it’s a 6-day-7-pill course, not 6-day-6-pill nor 7-day-7-pill.)

 
1. Research shows PEP would prolong window period and could delay seroconversion if it failed 

( for example,https://www.liebertpub.com/doi/full/10.1089/aid.2014.5319.abstract, https://www.ncbi.nlm.nih.gov/pubmed/25369451)

 I am wondering how long is the window period for me? since I can’t find the answer to that of incomplete PEP course in any guidelines.

 

2. If I was infected, would the 6-day-7-pill Triumeq PEP delay my HIV specific antibody response?

3. I took Triumeq TWICE (12 hours away) on the third day of the course and the drug concentration would be high than if it was taken once daily. Will the fact affect the validity of test results at 18 months after the 6-day-7-pill Triumeq PEP course?

4. Research shows that early treatment of ART in HIV infected patients may long effectively suppress viral replication even after the treatment stopped (https://www.ncbi.nlm.nih.gov/pubmed/20549847) and could blunt patients' HIV-specific antibody response and thus lead to long-term non-reactive or false negative testing results (http://ibase.info/htb/32657. http://programme.ias2017.org/Abstract/Abstract/1246)

I am wondering whether the research findings could apply to my case, and wondering whether my testing results are possibly affected by 6-day-7-pill Triumeq PEP course and become false negative? 

5. I haven’t had other exposures since then. The combo test came back negative at 559 days after the 6-day-7-pill Triumeq PEP and RT PCR was target not detected at 488 days and HCV was negative at 559 days. Could the 6-day-7-pill Triumeq PEP affect the validity of the test results after the ? Am I infected with HIV?

The data available on testing after PEP (or in persons on PrEP) are not very precise. The study you cite doesn't document whether the HIV infections in PEP users were acquired despite PEP, or after it was stopped. Most of them probably were reexposed after completing PEP. More research is underway, but all experts agree that testing is valid at 3 months, and certainly within 6 months, after completing PEP -- even when PEP is take for the recommended 4 weeks. Certainly after PEP for only a few dayts, all newly infected people would have positive test reults by 3-6 months delay is long enough. Your test results more than a year after your last possible exposure are 100% conclusive. You needn't worry -- for sure you do not have HIV and do not need any further testing.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

Thank you for your reply. Here are follow-up question: 

1. Would the rise in drug concentration affect the test validity? ( I took Triumeq TWICE on day 3 of the 6-day-7-pill course with 12 hours away to adjust medication timing.) 

2. All guidelines mention the window period is no more than 6 months after PEP, but it is for people who complete the 28-day full PEP course, right?

Nowhere can I find the window period in the guidelines specifically for cases of INCOMPLETE course of PEP like me; therefore, I am very anxious.  

Will the 6-day-7-pill Triumeq PEP course delay or blunt my HIV-specific antibody response if I was infected?

 Is 6 months long enough for the delay? Or it could be longer for the delay? 

3. Research shows that early treatment of ART in HIV infected patients may long effectively suppress viral replication even after the treatment stopped (https://www.ncbi.nlm.nih.gov/pubmed/20549847) and, with long-term maintenance of undetectable viral load,could blunt patients' HIV-specific antibody response and thus lead to long-term non-reactive or false negative testing results (http://ibase.info/htb/32657. http://programme.ias2017.org/Abstract/Abstract/1246)

1) No, this would have no effect.

2) Exactly right, and my reply above agrees it would never take more than 6 months. But no, I will not further explain why it applies to you. Why woudln't it?

3) As I said, you are misinterpreting the significance of these studies.

Stop searching the web, and stop trying to understand science for which you are not qualified. (Or, if scientifically qualified, go back and look again.) There has never once been a person who had HIV with the negative test results you have had. Accept it, suck it up, and move on.

Thank you for your response. 

1. There is another worrisome fact that I am afraid may affect the validity of tests. 

That is, I took pills for panic, anxiety, and sleeping disorder from Day 86 to 250. 

I am wondering whether the drugs would interplay with the 6-day-7-pill Triumeq PEP and thus affect/blunt HIV specific antibody response and lead to false negative test results if I was infected.

2. Dr. Handsfield, I've been worried for a long time.

Because if I had not taken PEP at all, I know the window period is 3 months. 

Or if I had completed the full 28-day course of PEP, I know the window period is 3~6 months as clearly indicated in guidelines from worldwide trustworthy organizations. 

 Thank you very much for your responses. I just organized your responses into the following points. Please kindly check the correctness of the 3 points to see whether I understand you fully correctly.  

(1). Even with an incomplete Triumeq PEP course (6-day-7-pill course), the HIV window period for me is no more than 6 months. 

(2). About the research, I am over-interpreting and misinterpreting the findings. The research findings about the relation between early ART treatment and long-term non-reactive/false negative test results in HIV infected patients can't apply to my case of incomplete 6-day-7-pill Triumeq PEP.

(3). Given my negative testing results (HIV Ag/Ab Combo test and HCV at 18 months and HIV RT PCR at 16 months after the 6-day-7-pill Triumeq PEP course), even with the incomplete PEP,  I can be assured that I am not infected with HIV and HCV from the TWO exposures, which occurred only four days away about 19 months ago. (The PEP is intended for the SECOND exposure of the two.)(Please considering the fact that I took pills for anxiety,panic, and sleeping disorder from day 86 to day 250 )(After that, I haven't had any other exposures.)

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Dear Dr. Handsfield, 

Please kindly answer to my concern about whether my taking pills for anxiety, panic, and sleeping disorder from day 86 to day 250 would affect the test validity and lead to false negative test results. (the drugs are named Faxine, Lorazin, Sitalo and Flupine respectively)(I also took Chinese herbal medicine intermittently)

And please  kindly check the correctness of the 3 points that I draw from your responses. 

Yes you can be 100% confident you do not have HIV or HCV.

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