[Question #6022] Valacyclovir and prednisone

19 months ago
Hi Dr's,
On July 19 I had protected vaginal sex and unprotected oral sex. She was bleeding a little bit, so of course I am worried about that because I have bleeding gums. On July 20th I had unprotected vaginal sex. On August 4th I got shingles. I was prescribed Valacyclovir and prednisone. 3g of valacyclovir a day for 7 days. Prednisone as follow 60mg for 3 days, 40mg for 2 days, 20mg for 1 day.  I got worry because everywhere I read it says shingles was linked to Hiv. On August 11th I took an oraquick mouth swipe test it was negative, on August 22nd I noticed that my tongue was white. Which I assumed it was oral thrush. on August 25th I took another oraquick and it was negative. On August 29th I went to planned parenthood and took a finger prick rapid blood test, I believe it was antibody only, it was negative. On September 3rd, which was a little over 6 weeks since my exposure. I went to my clinic and took a 4th generation ag/ab test, it came back negative. I was also prescribed medication for oral thrush for 14 days, which hasn't resolved it, so I was prescribed a different medication. My question is, since I was on heavy dose of valacyclovir and prednisone for a week, could that have affected my ag/ab test I took on September 3rd? Could that have prevented ag/ab production? Did I get a false negative from the ag/ab blood test? I read studies on that online of course. I am worried because of the shingles and oral thrush symptoms. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Welcome to the forum and thanks for your confidence in our services. I logged in soon after you posted your question:  most users shouldn't expect nearly real-time replies.

First and most important, your negative test resuls are valid; for sure you do not have HIV. Contrary to what you express, there are no medications (and no medical conditions) that alter the reliability of HIV testing, especially with the AgAb (4th generation) blood tests. This used to be a theoretical concern for the earliest HIV antibody tests, in presence of diseases or drugs associated with immue deficiency (advanced cancer, high dose immunosuppressive drugs, chemotherapy) -- but even then it was rare, if it occurred at all. And for sure the dose of prednisone you took could not have had such an effect. You'd have to take similar doses for a few weeks to impair the antibody response to any infection. Finally, both the newer (third generation) antibody tests and the AgAb tests eliminate all such concern. Indeed, in theory if immunosuppression inhibited antibody production, HIV antigen would persist in even higher amounts -- so the AgAb test might be even more strongly positive than otherwise. As for valacyclovir, it for sure carries no such risk.

You also seem to have a couple of other misunderstandings -- although they don't alter the main point, that you don't have HIV. Singles indeed is more common in people with HIV, generally with advanced infection (overt AIDS) -- rarely as the only manifestation of HIV, and rarely as a consequence of early (recently acquired) HIV. Blood exposure during sex doesn't materially raise HIV risk:  in infected persons, HIV amounts in blood generally are no higher than in genital fluids. And there has never been a proved case of HIV tranmission by cunnilingus, i.e. your oral sex exposure -- and since blleeding gums are common, there must have been billions of cunnilingus events in presence of bleeding or inflamed gums, and still no known HIV transmission. Finally, you didn't necessarily have oral thrush, which isn't the same as whtie coated tongue. And to the extent thrush can result from immune deficiency, that effect cannot happen so soon after acquring HIV. (Resolution of your white tongue on anti-yeast treatment doesn't necessarily confirm a yeast infection. It likely was going to clear up anyway.)

In other words, this was a low risk event. It wasn't unreasonable to be tested for HIV, especially in view of coincidentally getting shingles when you did. But regardless of that, and regardless of how high the risk was at the time of exposure, your test results are conclusive. You can move on without further worry and no additional symptoms.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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19 months ago
Thank you for your quick response Dr. I also mentioned in my question that I had unprotected vaginal sex on July 20th.  I am a bit reassured about my September 3rd test.  Thank you.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Your 9/3 test was >6 weeks after July 20, so the result is conclusive for that event as well as the earlier one.---
19 months ago
Thank you Dr. I am moving on! 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
That completes the two follow-up comments and replies included with each question and so concludes this thread. Thanks for the thanks; I'm glad to have been of help.---