[Question #6751] PEP HIV

13 months ago
Had unprotected vaginal sex with a 21 y/o Latina female 3/10 at around 10am, before we got into it she showed me her most recent test results (12/28/19) as did I (1/3/20). I asked her if she had been with anyone since her prior test, she said no - this turned out to be untrue, as her last sexual encounter was 2/23/20 - immediately after I experienced a panic attack and she felt how worried I was and tried to calm me down. We ended up going to a clinic together where she got tested with the rapid test (not sure what gen), her test result was negative, now I know there is a window period of course and she swears up and down the last time she had intercourse aside from me was with her partner she’s been dealing with for 2 years + (on and off), she also says this was her only other partner since her 12/28 test up until me and he also got tested recently (she asked him to according to her). Currently I’m freaking out and considering going to the ER to get PEP. I am worried that because her negative text on 3/10 was only 17 days after her most recent exposure she may be seroconverting. She has agreed to take another test in a week, I don’t want her to text me saying she’s positive and I’ve missed the window period to take PEP, please advise. 
13 months ago
Is there any test that me and her can go get that will be able to pick up antibodies or be conclusive with her last sexual exposure prior to me being 2/23/19. Also according to her they had sex often in February so I’m sure the 3/10 test alleviates her concern when it comes to him in question but still, I am still in contact with this girl even though my incessant questions have definitely annoyed her at this point. Please advice  
Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago
Welcome to the forum. I’ll be glad to comment. If I were you I would not be considering PEP For several reasons. They are as follows:

1.  Concerns about being in the “window period”  are overstated. Your partner has gotten this far without acquiring HIV and had her last sex with a known partner who had not infected her up till now. The probability that a heterosexual Latina woman is in the window period a few weeks after her last negative HIV test is very very small.
2.  Even if she has HIV, the probability of acquiring HIV from a single act of unprotected intercourse is less than one in 1000.
3.  Finally, as a practical matter, it is now more than 48 hours since your exposure. PEP is not recommended for persons who are more than 72 hours since their exposure and is of limited value for Persons who are 48 hours out.

I would be far more concerned about your risk for traditional STI‘s such as gonorrhea and chlamydia then your risk for HIV. If my assessment still does not reassure you, then she could have a viral RNA test for HIV performed. If it is negative at this time, you were not exposed. 

i hope this information is helpful to you. EWH
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13 months ago
Thank you doctor, do you know off hand if a rapid test (we got results in 20 minutes) would be able to detect anything 17 days post her last exposure? And I can take her to get an RNA do you know how long the results for that is? I’m looking up clinics now, or can I go the emergency room for that?
13 months ago
Sorry I am a little confused about what you mean in reference to the window period being overstated. And this is true she hasn’t gotten infected dealing with this partner for 2 years on and off but I guess it’s hard for me to believe anything she’s saying after the initial lie 
Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago
No rapid test will provide a reliable answer at this time.  The RNA tests are widely available but I would suggest that you call around to make sure it is availability.  Once a specimen is available the test takes less than 6 hours to perform in the lab but the reporting make make it longer to be available to you.

By overstatement I mean that exposure to a partner in the window period is a very rare event.  Fewer that 50,000 out of more than 300,000,000 Americans will acquire HIV and most of those will be men with male sex partners.

I think your skepticism regarding her “lie” is overstated.  Many persons in similar situations would deny other recent sex partners.  EWH
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13 months ago
Thank you kindly doc. I will go to a quest diagnostics with her tomorrow, I’m reading about the pcr rna and apparently false positives are possible even with trace amounts?
Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago
False positives are possible but relatively rare.  EWH
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13 months ago
Hi Doc, hope this finds you well — well she took another test 23 days post her most recent exposure with her ex it also came back negative, I know it’s not conclusive (5 days out) but was wondering what % you’d put on it, I don’t know if I should continue to worry, I got all my results back as well for other STI’s and was all clear, she was too 
13 months ago
It was a 4th gen duo combo test 
Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago
This will be the final response.  We typically provide three responses to each question.  This is your 4th.

As I’ve already told you, the chance that she was in the “window period” were vanishingly low before she was tested and are lower still.  I will not put a precise number on the proportion of infections detected at 23 days.  Rather I will, once again state that your risk is very,very low.  You need to relax.

This will end this thread.  There should be no need for further questions on this exposure.  EWH
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