[Question #5417] Follow up on question 5384

23 months ago
Hello Doctors,

First of all I want to say thank you all for the information that you give on this site and I want to thank Dr. Hook for answering my previous question, it really has helped me with my anxiety a lot and I feel more relaxed now with the advice I was given by Dr. Hook.

I just want to clarify something on my previous question since I keep searching online and keep getting conflicting information and I wasn't able to clarify on my previous question. On my previous question I asked if it was ok to test 4 DAYS after completing PEP? Since my incident was on 04/29 around 3am, I complete PEP on 05/26 and have a follow up appointment and test on 05/30 with a 4th gen test, I want to know, can I consider the results of the test conclusive?? Does PEP affect the test or as I read online, delay seroconversion?? I've seen articles that say it's fine to test immediately after PEP and some that say you have to wait an additional 4 weeks after the last dose of PEP to consider the results conclusive so I am confused and looking for guidance. I know Dr. Hook already explained that my incident is no risk (as well as many other people) but for some reason the fear still gets the better of me. 
Edward W. Hook M.D.
Edward W. Hook M.D.
23 months ago
 I am sorry that you continue to worry about the event that you described in our earlier exchange. The question you ask now however was already answered. Testing to determine the effectiveness of PEP four days after  completion of the medication is too soon. As I said in my final response to your last set of questions, four weeks is  almost certainly sufficient time to allow test results to accurately reflect whether or not you were infected. Four days is too soon. And conservative agencies such as the CDC state that while four weeks is probably accurate, definitive results could be obtained at three months  after completion of PEP.

 It is clear that you continue to worry about your experience as is appropriate following being the victim of a sexual assault. I suggest that you seek counseling regarding the experience to help you move forward.  OTOH, Repeatedly visiting  the Internet  however is absolutely the wrong thing to do. While a wonderful means of communication, much of the so-called information on the Internet is taken out of context, out of date, or just plain wrong.   The Internet will only miss lead and confuse you further.

 I hope that these comments will be helpful to you.  EWH
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23 months ago
Hello again,

Many thanks on answering my questions Dr and I was wondering if you could answer a couple of more questions regarding testing.

I am not going to ask whether my scenario was a risk or not because as you have stated and many others have, I had little to no risk of HIV.

On 05/30 I went to go see the doctor that prescribed PEP to me because he scheduled me to come back and see him and he ordered a 4th generation HIV test but he said to come back until 6/18 for the results. Me being really anxious I could not wait an additional 2 weeks just for results so the next day I went out and tested on my own at another clinic with a 4th generation test. I just got back the results today which was negative.

I know you already stated in my previous question that 4 days is too soon to test and it's better to test at 4 weeks post PEP (which I plan to do) but can I consider these test results good indicators and relax?? Have you ever seen someone test negative immediately finishing pep to have their results change at 4 weeks post pep? I've seen articles online from other doctors that said they have never seen a negative test immediately after pep turn positive at 4 weeks, except once where the patient kept engaging in high risk exposures. And lastly, any idea why the doctor that prescribed me pep ordered another test if it's too soon? Would really like your input 
Edward W. Hook M.D.
Edward W. Hook M.D.
23 months ago
Of course having a negative test within a week of completing PEP is good news and, as you know, your risk for infection was already low.  At the same time, the reason for the recommendation is because persons have had their infection show up in the first few weeks following PEP.  Thus, while your result is good news, it is not yet conclusive.  That said, as I have already said, you have little reason to worry.  

I suspect that your doctor ordered the test because it was the path of least resistance and rather than deal with your anxiety, he ordered the test he thought you wanted.  EWH
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23 months ago

Hello Dr.

Once again many thanks for your insight into my case, it has really helped me deal with this whole situation, but from time to time I still get some anxiety because I tend to really overthink stuff and I cannot wait to test again 4 weeks after completing PEP which will be on the 24th of this month so I can get a definitive result and close this chapter in my life and move on.

 Just a couple of final questions to close this thread, 10 days after I stopped taking PEP, I started to have some headaches around my forehead like I had a really tight sweatband around it, had a minor sore throat which only lasted a day and some lower back pain and some mild pain around my shoulders and neck, I haven't had a fever and no rash but I did notice a small bump on the side of my neck just below my left ear and I thought it was a swollen lymph node but it looks and feels too small and you can't really notice it unless you actually stare at it and look for it, I think it may have been there this whole time but just now I am noticing it and I am freaking out about any little change in my body. Me being the anxious person that I am, I looked up ARS symptoms and some do include the ones I listed, but then again since I've been having a lot of anxiety during this whole time, I looked up physical symptoms of anxiety and the symptoms are almost the same. I know it's probably nothing and I think my symptoms have more to do with anxiety than HIV but my question is, does PEP delay ARS symptoms?? Or if by some astronomical fluke I really was exposed, would ARS symptoms have showed up when I was taking the PEP? Would 6 weeks be too late for ARS symptoms to show up regardless of PEP?? Or do you think I am just overthinking stuff again and my symptoms are just physical manifestations of anxiety?? I know it's hard to talk about symptoms over the internet, but I wanted to get your insight one last time. Again thank you for your time doc and have a great day.

Edward W. Hook M.D.
Edward W. Hook M.D.
23 months ago
I'm sorry you continue to worry about this.  The symptoms you describe really do not sound like the ARS to me- the sore throat of ARS is severe, there is typically a high fever, and most people have severe muscle and joint aches.  The symptoms, you describe, as you have already suggested, are more consistent with anxiety (which we both agree is an issue for you) than the ARS.  In answer to your question however, indeed, by suppressing the virus, were you have been exposed (doubtful) and were you infected, PEP could delay ARS symptoms until 10-15 days after completion of PEP.  It would be virtually unheard of you to develop ARS while taking PEP.   

I hope this information is helpful.  I really would not be worrying and hope that my comments will help you to not worry.  As you point out, since this is your 3rd question and response, as per Forum guidelines, this thread will now be closed.  EWH
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