[Question #5949] Hiv risk - pep: continued

19 months ago
Hi doctor. Its me again. 

I got this flu now with no fever. But the other thing is: my right lymph node on the neck is enlarged for about 3 months now after a respiratory infection (sinus) but in the past couple of days, the left node in the neck started gradually increasing in size. Now today on 9/2, at 2am, I woke up night sweating and I could see I am sweating alot but not drenched just feeling hot. 
Could this be anything related? I’m worried like hell now and getting frightened. Please help me. 

Thank you 
19 months ago
And both lymph nodes do not hurt on touch or  iif I move them. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Welcome back, but sorry you found it necessary. I reviewed your other thread to remind myself of that discussion. You had a very low risk exposure with virtually no risk of HIV, but because you took PEP, you'll need delayed HIV testing to confirm you were not infected. 

Your symptoms are not typical of a new HIV infection. Any number of other conditions are more likely. But you should have an HIV test now:  a negative result would prove with 100% certainty that your symptoms are not from HIV. (The blood tests ALWAYS are positive in people with symptoms caused by HPV.) Discuss this with the doctor or clinic where PEP was prescribed, or perhaps with an infectious diseaeses or HIV/AIDS specialist.

I will have no other advice until and unless you have seen your doctor and had a new HIV test, at which time I'll be happy to comment further. But stay mellow in the meantime. I'm sure you don't have HIV.

HHH, MD
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19 months ago
Hi doctor,

Below is the complete timeline with dates of tests and PEP. Can you tell me which tests need to re-done so I can request the NP to give me these tests. 

Encounter: 7/14
PEP started: 7/16 
PEP ended: 8/13

Tests:
HIV: 7/23 (part of guideline since pep was given)
HEP B: 7/23 (antibody reactive since I got vaccine when I was young)
HEP C: 7/23

7/30: 10 days post exposure

Chlamydia (urine)

Gonorrhea (urine)

Trichomonas (urine)


Syphilis: 8/2


Not done:

HSV, HPV


Please tell me which ones other than HIV should I retake?


Thank you. 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Hello again. Your question arrived while I was logged in, hence a faster than usual reply.

All your test results are conclusive, no further testing necessary except HIV.
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18 months ago
got an hiv test as you have suggested and below is the complete time line.

Protected incident: July 14
PEP initiated: July 16
PEP completed: August 13

First HIV test: July 23(as part of guidelines)

Latest HIV test: October 4
Days completed after incident while testing: 83
Days completed after PEP while testing: 53

The latest HIV 1/2 Antigen/Antibody,4th gen W/RFL: Non-Reactive. 

Is this test conclusive that I’m not infected and I can take my head off of this and move on? Just curious since the NP who was working with me said I have to come back for more tests at 6, 12 and 18 months. Is this the case since my exposure was low risk?

Thank you again for your help Dr. HHH. You have been my savior by reducing my anxiety with your responses. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
You can consider your latest result conclusive, especially since there was no risk of HIV to begin with.

There are no good data on how long conclusive testing might require if PEP has been taken but fails. PEP failure is rare, so there are not enough cases to provide meaningful data. That's why expert advice varies on when final testing should be done in this situation. Personally, I am confident that the AgAb test would pick up all new infections 30+ days of stopping PEP, and that your negative result at 53 days is conclusive. Most other experts would agree. However, some experts take a more conservative view and advise final testing 3 or even 6 months after completing PEP. If you had actually had an exposure with any risk at all, I would advise another test at 3 months. But you didn't -- there was simply no chance you caught HIV and, as we discussed previously, it was a mistake to have taken PEP in the first place. If I were personally in your situation, I would not have any more HIV tests and would be continuing unprotected sex with my wife with no concern about HIV transmission.

Your NP's advice about testing at 12 and 18 months is nonsense. I am not aware of any experts who advise a need to test any later than 6 months after completing PEP.

That completes this thread. Please do not start a new one for any furhter discussion about this exposure. If you go ahead with any additional testing, there is no need to confirm that those negative results are conclusive. For sure any additional test will remain negative, and such a question would risk being deleted without reply, because of the policy against repeated anxiety driven questions. Thanks for your understanding. 

I hope the discussions have been helpful. Best wishes and stay safe.
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