[Question #8015] The case of Mississippi Baby (for Dr., Handsfield)

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49 months ago

Dear Dr. Handsfield,

Sorry, I am here to ask questions again. Please don't be mad. Please kindly help. 

I had two exposures in the same week, only four days away. I was on Triumeq PEP(not Truvada PrEP) at 40 hours after the second exposure, but I didn't complete the full 28-day course. I took 7 Triumeq in six days (I took it twice on the third day to adjust medication timing, so it’s a 6-day-7-pill course, not 6-day-6-pill nor 7-day-7-pill.)

 I feel relived after reading your replies months ago, but recently I started feeling worried after knowing there was a case of "the Mississippi Baby" the other day. (https://www.hiv.gov/blog/mississippi-baby-now-has-detectable-hiv-researchers-find)

The baby was reported to become HIV positive after a 27 month of HIV negative responses. She received antiretroviral therapy at 30 hours after her birth and the therapy continued 18 months. 

Dear Dr.,

It seems early antiretroviral therapy can lead to long term HIV negative responses after it was stopped.  I am wondering if I was infected in the first place, whether the virus can hide somewhere in my body (in latent reservoirs) for years and just hasn't been activated yet due to the 6-day-7-pill Triumeq course, just like the Mississippi Baby and other adults HIV patients who received very early antiretroviral therapy and experienced years of HIV negative responses after the therapy stopped, but the virus was activated and rebounded after years.  (https://pubmed.ncbi.nlm.nih.gov/20549847/)

I am afraid of the possibility that I am just like them and that the tests results I have had are false negative because of the 6-day-7-pill Triumeq PEP (as a form of antiretrovirl therapy). The HIV combo ag/ab test came back negative at 42 months after the 6-day-7-pill Triumeq PEP course and RT PCT test is Target Not Detected at 24 months. I haven't had any exposure since then.


Dear Dr., Handsfield, Are my doubts warranted? Please don't be mad, thank you very much!

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H. Hunter Handsfield, MD
49 months ago
Welcome back, but I am sorry you remain so abnormally concerned about HIV. 

You don't describe your recent exposures, but I would recommend that if you're going to take PEP, you compllete the recommended duration (4 weeks). Or consider PrEP, including PrEP on demand, as we have discussed previously. It is quite irrational to be so afraid of HIV and then not follow the correct prevention recommendations.

The circumstance of a premature infant, born to an HIV infected mother, then treated with anti-HIV drugs, with a long delayed positive diagnostic test, is entirely irrelevant to sexual exposure. There has never been a known case of HIV with such long delayed positive test results of the sort you describe. The other study you cite concerns patients with KNOWN infection with POSITIVE tests who later had undetectable antibody. It was a single research report that has not, to my knowledge, been replicated. Since it disagrees with all other scientific reports, I believe it can be discounted.

You need to learn to accept your negative test results. It is clear you do not have HIV. I strongly recommend professional counseling. It is not normal to remain so fearful and doubtful after all the reasoned, science-based reassruance you have had -- not only on this forum, but probably from your own doctors. In any case, this forum cannot help you further. There will be no further discussion on this thread. And repeated anxiety-driven questions are against forum policy -- so this must be your last question on these topics; any others will be deleted without reply, and without refund of the posting fee. Thank you for your understanding.

I do hope the discussions have been helpul. Please take seriously my recommendation for professinal mental health care. Good luck.

HHH, MD
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