[Question #5515] HIV ARS Follow Up Questions

20 months ago
Dr Hook, thank you for your help in my previous post from yesterday. 

I was able to get in to see my family Dr today and they ran another 4th Gen finger prick test. The results where negative. 

I’m feeling better today. I was able to figure out what was causing the dry mouth, it was an interaction of a Rapaflo drug with the PEP.  

Today, my temperature has been elevated which has been concerning. Its been running 98.6 - 99.5 all day which is about a point higher than normal for me. 

Couple of questions, as you can probably tell I’m a fact gather:

1) I’ve now been on PEP 1 week and am 16 days from the initial (with condom) exposure, how reliable would today’s test me for me? If my fever where from HIV would my test still show positive EVEN if I’m on PEP for the last 7 days?

2) The HIV RNA test from Labcorp is from what read positive or negative. I guess there is a different test that gives you a count as well. Anyway, since mine was negative on day 11 (within window) but had been taking 3 doses of PEP before taking it, would I be able to rely on that test? I was having “symptoms” at that point but from what I do not know. Would the 3 days of PEP have tricked that test?

3) Lastly, does HIV on the surface of the condom cause any risk to sores on my scrotum?  Is it true that HIV dies when it’s exposed to the air? 

4) Is PEP reliable if started 22 hours from (possible) exposure?

I’m sorry for asking another question, I’m just trying to understand the science so I can help put my mind at rest. 

All this consisting, I did use a condom both times and they remained fully intact for both encounters.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
It's my turn to pick up new questions, so you've got me this time. (It arrived when I was logged in. Most users should not expect nearly real-time replies.)

I reviewed your discussion with Dr. Hook and agree with all he said. The chance you caught HIV is virtually zero and disagree with PEP in this situation. Among the downsides of PEP, which you now will experience, is that the time to reliable testing -- to diagnose HIV in case PEP doesn't work -- is not well known. Probably most people would be positive with only modest delay, e.g. conclusive AgAb (4th generation) testing by 8 instead of 6 weeks after exposure. However, because this isn't certain, most experts recommend extending testing to at least 3 months. The downside is that the period of uncertainty -- often a big deal for especially anxious persons, like you -- is much longer than it would have been without PEP. But there's no getting around it; you're not going to have conclusive test results until at least 3 months after the last sexual exposure.

However, the details are up to your GP, since apparently s/he is the one who prescribed PEP. (If not highly experienced in HIV management, maybe ask for referral to someone who is, or consult with your local NHS GUM clinic.) We carefully avoid actually providing direct medical advice, so I will have nothing more to say about the timing and interpretation of your test results after you complete PEP. 

That said, brief replies to these questions:

1,2) To my knowledge and understanding, there is no point at all in testing while taking PEP. Testing will become increasingly reliable each week after you have completed PEP.

3) Zero risk from this part of the exposure. You can't have enough exposure to catch HIV by skin exposure, even with superficial cuts etc.

4) PEP is believed to be highly reliable if started within 48 hours, questionable from 48 to 82 hr.  22 hr is fine.

"I did use a condom both times and they remained fully intact..."  -- is why you should not have sought PEP and if you had come to my clinic, we would not have prescribed it (assuming you correctly described the exposure without exaggerating the risk).

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
To clarify one point, there is no meaningful difference on time to conclusive testing between me and Dr. Hook. He advised 4-6 weeks after completing PEP. With a month of treatment, that's equivalent to my advice for 3 months after the last exposure.---
20 months ago
Wow thank you Dr for such a quick reply.!! 

My fears surround the symptoms I’ve had (am having) they are what’s been driving my quest for information and all the testing. 

Do you agree that if I was experiencing symptoms from HIV ARS one of my test would early or later would have shown us something?

Would it be very, very unusual for someone to have ARS symptoms during the PEP? 
20 months ago
Just following up on one comment:

"I did use a condom both times and they remained fully intact..."

This is the entire scope of the encounter. There was no oral or anything outside this encounter besides some simple kissing.  Heck I even checked the condoms after the encounter by blowing in them. I am guilty of OCD for sure.  Lol 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
Oh, come on. Get real. You cannot have ARS symptoms while taking anti-HIV drugs. And your sympttoms don't siuggestt ARS anyway. It isn't the individual symptoms that suggest ARS, but the pattern (combinations of the right symptoms) and timing. And the pattern and timing of yours don't come close. Do your best to ginore your symptoms. Keep working with your GP, and I also siuggest you seek counseling for your OCD. That's the only health problem in evidence here. I suggest iit from compassion, not criticism.---
20 months ago
Dr Handsfield, thank you. 

I’m trying to reconcile your thoughts with Dr Hooks thoughts which brought great relief. Let me explain:

I had two encounters, both with condoms. The symptoms I had/have are what’s freaking me out. I hope the timing is wrong but let me explain.

May 26th - Encounter
June 2nd - Encounter 
June 3rd - Started PEP
June 5th - Felt Nausea, unwell, swollen lymph node under ear
June 6th - Loss of Appetite, Nausea
June 7th - Loss of Appetite, Nausea 
June 8-9 - Started feeling better but even to today I woke up with some nausea

The first systems appeared three days after starting PEP but 10 days from the first encounter. I gathered from Dr Hooks option that my testing, while symptomatic after 3 and 4 days of PEP (including RNA after 3 days of PEP) would have likely produced a positive result from the first encounter if I had HIV ARS. Essentially saying that 3 days of PEP wasn’t enough to make the virus be undetectable if I was symptomatic. 

Does that make sense?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
20 months ago
Symptoms of ARS are caused by the body's immune response to HIV, and therefore cannot start immediately. They begin when antibody first is produced, generally no sooner than 7-10 days after catching the virus. Symptoms earlier than that cannot be due to HIV. Similarly, that's why you cannot have HIV/ARS symptoms while taking PEP, which suppresses the virus and rpevents antibody formation (also explaining the delayed positivity of blood tests). And as I said before, your symptoms are not typical of ARS anyway. Probably they were side effects from the PEP drug(s), especially loss of appetite and mild nausea; or anxiety over the exposure etc.

That completes the two follow-up comments and replies included with each question and so ends this thread. Please do not start another one on this exposure, your PEP treatment, and symptoms. If you would like to return after enough time has passed for conclusive testing and report the result (i.e. about 3 months from now), feel free to do that. OTOH, there should be no point in telling us about your negative results -- we will just confirm it is reliable, if done at that time. Continue to work with your own doctor about any symptoms or concerns that arise in the meantime.

And stay mellow! Your chance of being hit by a meteorite is a lot higher than the likelihood you have HIV from the exposure described. If you find yourself still worrying, I suggest you start with your first thread and carefully re-read every response you have had there and in this discussion. Almost certainly any new questions that come to mind have been answered, or the answers should be obvious from our comments.

I hope the discussion has been helpful.