[Question #7368] Concern About Prep affecting Acute Hiv Diagnosis

5 months ago
I I had a risky exposure with a guy who said he was undetectable August 14,2020. That following Tuesday I had very bad stomach pains and body felt warm even though my temp was normal. The following week I had diarrhea for 5 days and developed a white tongue which I still have almost 3 months later. I went to the local HIV clinic August 28(14 days after exposure) for a baseline test that came back negative. September 1( day 18)I got tested with the HIV 1+2 AB + HIV1 P24 AG, QUANTITATIVE IMMUNOASSAY, SERUM . That came back negative as well. So I started PREP Descovy on day 20 and took the HIV RNA test on day 25 due to my anxiety and it came back non reactive. I also took another 4 gene test on day 60 after exposure that came back negative . I’m worried that prep has delayed the process of my body produces HIV antibodies . My 12th week test is this Saturday(day 84)will it be conclusive or did Prep prolong that? Would any of this test picked up HIV since I started experiencing what I thought were symptoms 3 days later after exposure?
Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago

Welcome to the Forum.  Thanks for your question.  I'll be glad to comment.  Several background comments:

1.  The consensus amongst experts is the undetectable = untransmittable.  Thus if your partner was undetectable, the encounter you describe was a no risk event.

2.  For persons who are truly compliant with their PrEP and do not miss doses, there are too few failures to accurately comment on what PrEP failure looks like. 

3.  When persons are symptomatic due to HIV, invariably, they have detectable HIV.

In your specific case, all things considered, your risk for infection was low if not zero.  Were you infected, while theoretically your PrEP might lead to concern about delayed positivity, for all practical purposes, you can be entirely confident that your tests are accurate and that you have not been infected.  In addition, were your symptoms truly due to HIV, your PCR test would have certainly positive.  I urge you to assume that the symptoms you describe were due to something other than HIV.

I hope this perspective is helpful. EWH

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5 months ago
I started prep after the exposure. They guy lied at first about being infected so my trust level with him is extremely low. Just wanted to make sure that my test could give me peace of mind.
Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago
Understood.  That your partner lied is unfortunate.  Nonetheless your test results are reliable.  EWH---
5 months ago
Ok thanks. Got my last Fourth Gene today( day77) and it was negative.
Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago
Thanks for sharing your results.  I hope that they will now allow you to move forward without concern.  Take care, stay safe.  EWH
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5 months ago
One last thing . My doctor ordered a blood test to see why my tongue is white and my absolute neutrophils is low at 1436 normal is above 1500. Could this be the cause of Early HIV  infection? 
Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago

No, early HIV is not a cause of a low white blood count.  Rather it tends to occur in the late stages of disease.  While your count is slightly lower than is usual, unless there is something else going on I would not worry about it (your doctor is the person best equipped to address this.  Be confident however that it is not due to HIV).

As I suspect you know, we provide up to three responses to each client's questions.  This is my 3rd response.  Therefore the thread will be closed shortly without further responses.  Take care, please don't worry.  EWH

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