[Question #6325] High risk exposure pep plz help

16 months ago

Jj

H ello, im male 31 I had a unprotected BJ receptive and giving and receptive anal sex unprotected for 10 minutes with edjaculation the person was uncircumsized gay male unknown status. No way of contacting him as it was a one night stand. Im normally straight and first expirience and didnt realise what danger i was in. 

I went on pep at 60 hours. May have been to late as 3 days after pep started i had white excudate on my tonsils no swelling or pain. Then 5 days after starting pep 8 days post exposure i had these symptoms between 8th day till now 7weeks! Generalised lymph node swelling and pain behind knees, groin, lower back, spleen, armpits, under jaw, below ears, behind head (occipital) swelling lasted 3 days then went down and left me with throbbing pain in each location in all locations on and off and gradually got less and less over 6 weeks till now i only have pain in my armit nodes and occipital nodes. My tonsils have been swollen not massive for the entire 6 weeks and wont go down. They give pain in conjunction with the moving lymph pain. 9th day i had a severe headache like ive never had! sensitive to light and pain behind eyes and couldnt move my neck sideways for 1 day. 

I had white stuff that smelt on my tounge for about a week near the start. No rash. I think i had fever for a few days but not sure. No fatigue really. After 7 weeks i still have mild pain in tonsils which are still slightly swollen and yesterday i had contant pain in my armit nodes. Im devastated.

Testing 4th gen Lab 2 days after pep - negative

4th gen Lab 1 1/2 week after pep  - negative

 Alere 4th gen combo finger prick test 2 weeks after pep - negative. 

Do you think this is seroconversion? I have seen differing info on whether you can get ars symptoms while on pep. Some experts say you can if pep has failed.

If it was seroconversion has it been reduced in severity  by  the pep driving the viral load down which would exlain not such bad fatiuge and fever as my body has not had to battle so hard? 

How reliable are my tests so far?

Im very worried and convinced i have contracted HIV from this stupid incident. What else could it be? 

Has the pep stopped antibodys being produce so that the 2 week post pep test didnt pick it up? 

I have not gone to work in 2 months due to the stress of this and the illness i have been feeling. If you could be very honest with me and if you have got any ideas that its not Hiv i would appreciate it. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 months ago
I am eager to help, but your question is illegible. You have written it in another program, with color(s) that are not visible when pasted into our system. I will be happy to respond after you re-write your question directly in a follow-up window below. Please also assure it meets the lengh standards, i.e. no more tha 1,500 characters. Thanks!---
16 months ago
Hello, im male 31 I had a unprotected BJ receptive and giving and receptive anal sex unprotected for 10 minutes with edjaculation the person was uncircumsized gay male unknown status. No way of contacting him as it was a one night stand. Im normally straight and first expirience and didnt realise what danger i was in. 
I went on pep at 60 hours. May have been to late as 3 days after pep started i had white excudate on my tonsils no swelling or pain. Then 5 days after starting pep 8 days post exposure i had these symptoms between 8th day till now 7weeks! Generalised lymph node swelling and pain behind knees, groin, lower back, spleen, armpits, under jaw, below ears, behind head (occipital) swelling lasted 3 days then went down and left me with throbbing pain in each location in all locations on and off and gradually got less and less over 6 weeks till now i only have pain in my armit nodes and occipital nodes. My tonsils have been swollen not massive for the entire 6 weeks and wont go down. They give pain in conjunction with the moving lymph pain. 9th day i had a severe headache like ive never had! sensitive to light and pain behind eyes and couldnt move my neck sideways for 1 day. 
I had white stuff that smelt on my tounge for about a week near the start. No rash. I think i had fever for a few days but not sure. No fatigue really. After 7 weeks i still have mild pain in tonsils which are still slightly swollen and yesterday i had contant pain in my armit nodes. Im devastated.
Testing 4th gen Lab 2 days after pep - negative
4th gen Lab 1 1/2 week after pep  - negative
 Alere 4th gen combo finger prick test 2 weeks after pep - negative. 
Do you think this is seroconversion? I have seen differing info on whether you can get ars symptoms while on pep. Some experts say you can if pep has failed.
If it was seroconversion has it been reduced in severity  by  the pep driving the viral load down which would exlain not such bad fatiuge and fever as my body has not had to battle so hard? 
How reliable are my tests so far?
Im very worried and convinced i have contracted HIV from this stupid incident. What else could it be? 
Has the pep stopped antibodys being produce so that the 2 week post pep test didnt pick it up? 
I have not gone to work in 2 months due to the stress of this and the illness i have been feeling. If you could be very honest with me and if you have got any ideas that its not Hiv i would appreciate it. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 months ago
Thanks for reposting -- and for your confidence in our services. Welcome to the forum.

It is unlikely you have HIV. PEP is highly effective. Although ideally started within 24-48 hours, I have not heard of it failing when started within 72 hours. Second, your symptoms starting at 5 days -- while on PEP -- almost certainly were not due to HIV. When PEP fails to prevent HIV, it does prevent symptoms of ARS, for the same reason that the blood tests remain negative:  the symptoms of ARS are due to the body's immune reaction to the virus, as reflected by HIV antibody tests. Your negatiive AgAb (duo, 4th generation) test results at 2 weeks did not prove you didn't catch HIV, but they do show that any symptoms you were having were not ARS. Any ARS symptoms would be expected to start 10-14 days after completing PEP.

That's because when PEP fails, probably the sequence of virus appearance in the blood (RNA and p24 antigen) and antibody is pretty much the same as when PEP isn't taken, with the starting point a couple days after completeing PEP instead of the exposure event. By 1.5-2 weeks probably roughly half of infected persons would have positive results with the AgAb tests. Therefore, your test results so far are only modestly reassuring. Presumably your PEP was prescribed by a clinic or doctor who is still following you, and probably has given you similarly reassuring information so far. You could ask them about having an HIV RNA test, which would be even more reassuring, perhaps 90-95% reliable. But the final conclusion that you didn't catch HIV is still a few weeks away:  that will come with another AgAb test (preferably lab based, not a rapid test) 6 weeks after completing PEP.

This doesn't mean I think there is a high chance you caught HIV. Even with receptive anal sex with ejaculation by a known infected partner, HIV transmission occurs under 1% of the time, so the odds you were infected were pretty low even without PEP. With that treatment, even started on the late side at 60 days, the chance you have HIV is very low. I expect your additional test results to remain negative.

FYI, you'll see other advice on this forum about testing as late as 3 months after completing PEP. By chance, just a couple days ago I exchanged emails with an internationally respected expert whose research emphasizes early HIV infection, ARS, PEP, and PrEP. She considers a negative AgAb test 6 weeks after completing PEP as conclusive, which will be our advice on the forum from here on. You happen to be the first to raise the question since that conversation.

I won't bore you with the condom lecture -- you seem to have learned that lesson!

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

HHH, MD
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16 months ago
Hi  thank triple H have you ever thought about wrestling? You would have a good rival there haha. Thankyou for the response. Back to how my life got twisted upside down. its great that you have set up this forum. 
Would all the nodes in my body going down and gradually fading mean that my body has beaten whatever virus it was? It could also be me moving into asymptomatic stage i suppose. 
In your medical expirience have you come across swollen tonsils that have been present for 7 weeks? 
I literally felt whatever it was start in my knee nodes and work its way through my lymph system ive never felt anything like it it sent me into panic mode and now i am on anti depressants for the first time in my life and they are helping me get through this. I was suicidal but now im a bit more level headed.
I also forgot to mention that i had drug interactions and on day 4 5 6 7 of pep starting i took multivitamins with zinc in and rennie some evenings right before my raltegravir then saw on the instructions and i was devastated as i may have made it fail due to drug interactions.what do you think about this
My symptoms did start properly from 8 days onwards i inly had white excudate on my tonsils from 5 days after exposure. so if it had been seroconversion the 6 week test post exposure would have picked it up so i have no idea what it is or was. 
Yes unfortunately i have read in places that if the source is hiv positive with a uncontrolled viral load My chances are 1 in 3 of contracting it. Im praying im going to be ok. 
Today after 7 weeks is the first day i have felt almost normal its only my tonsils giving a bit of pain and occipital lymph nodes.  
When would you feel a PCR Rna test would be accurate? As i thought pep could affect it up to 2 months after pep
How long does it take for pep to stop affecting test results? 
The people that put me on pep were not massively knowledgable i felt i was teaching them things at times and that doesnt put my faith in them much. Plus they did not tell me about drug interactions which may have screwed me for life.
Ok yes testing 6 weeks post pep  is actually what i was amaing for which will be mid december. So at least i know it will be good enough to relax. it will either be a great christmas or the worst ive ever had. I pray every day literally that this virus can be taken out of my body if its there. 
Sorry for jumbled questions etc 
Thanks for your help.

Also i paid for 2 questions by accident shall i just keep it for follow up stuff or is that not allowed? Thanks 




16 months ago
And what do you think the percentage reliability  is on a 4 week post pep 4th gen ag/ab lab test ? Can i rest a little easy after that? Thankyou 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 months ago
Of course I have seen enlarged tonsils lasting several weeks. All doctors have; it's very common. Your test results prove that neither this nor your other symptoms are due to HIV, regardless of their timing. If they continue or you otherwise remain concerned, discuss with your doctor.

I can't comment on the expertise of the doctors who prescribed PEP. The supposed drug interactions don't exist, to my knowledge. Search online for "drug interactions" to find several helpful websites. One of the main ones (drugs.com) shows no interactions between raltegravir and zinc or vitamins. Even if there were a problem, any reduced effectiveness for 4 out of 28 days probably makes no difference. It is likely that PEP for 1-2 weeks would be effective.

The time PEP delays reliable HIV testing is discussed in detail above. Re-read my reply. A negative AgAb test 4 weeks after completing PEP will be at least 95% reliable, hence very reassuring.

You can expect a great Christmas, not a bad one. There is almost no chance you have HIV. Believe it!
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16 months ago
Thanks so much for the reply and you really are helping. 
I did forget to mention I did a PCR RNA test at 11 days post pep. Whats the accuracy of that please?
The 4th gen at 1 month post pep will be the one then if i get a negative then i will prpb go back to work.
Yes magnesium in rennie interacts with raltegravor unfortunatly but like you say hopefully it will be ok 
Thanks Sir 
16 months ago
Sorry by accuracy of the RNA test i meant would pep still have the viral load at UD leading to a false negative?  If not whats the reliability it could have picked up infection in percentage roughly? Thanks
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 months ago
Magneskum-containing antacids can reduce absorption of raltegravir if the two are taken within an hour of each other, but not by a lot. If you were to take both throughout 28 days, it would modestly reduce the blood levels of the drug, but not necessarily by enough to cause reduced effectiveness. But again, it was only for four days!

The RNA test detects around 80% of HIV infections at 11 days after exposure. It's probably about the same after PEP.

Each question comes with two follow-up questions and replies. If you would like advice about your final test results, I would suggest waiting until you have your AgAb test result 6 weeks after completing PEP. In the meantime, try to start thinking objectively and analytically, not emotionally. Re-read all my comments above and interpret them with the optimism intended, and do your best to stay mellow in the meantime.

Perhaps you would also like to know tha tin the nearly 15 years Dr. Hook and I have been moderating this and a previous similar forum, with thousands of questions about HIV exposures and test results, not one person turned out to have caught HIV. You're not going to be the first! If and when that happens, I expect it to be from a truly high risk exposure, and not following PEP.
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16 months ago
Ok thanks DR Hook. I really hope you are right and I have not been infected. I will return to use my second question purchase to tell you what my result is at 6 weeks.   Hopefully i can have a happy christmas. I hope you enjoyed your thanks giving. Goodbye for now. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 months ago
I think you should save the money; I'm going to ask the forum administrator to refund your extra purchase. You can always start a new thread after your 6 week test result, but if it's negative I don't see the point -- either I or Dr. Hook will simply agree with the negative result, and neither of us will have anything more to say about the exposure, PEP, test results, etc that has not already been discussed. In the exceedingly unlikely chance you have a positive HIV test result, of course we would love to hear it.

I do hope the discussion has been helpful.
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