[Question #8247] Testing After PEP
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47 months ago
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Hello, I had a risky exposure where I had unprotected receptive anal sex with an unknown status stranger approximately 12.5 weeks ago. I went on PEP 36 hours after the encounter. My PEP regimen of Truvada and Isentress was screwed up and I only received half the medicine of Truvada between weeks 1-2. I still completed the 4 weeks of PEP. 12 weeks post encounter and 8 weeks off PEP I had a 4th gen HIV blood test which was negative. I also tested for herpes and was positive for HSV 1, which was previously negative so I know I got it from this encounter. I have been looking through posts regarding testing after PEP and I have seen you say conclusive testing 6 weeks after PEP, as well as 3 months after PEP. Some questions I have:
How reassuring/conclusive would my HIV test be 8 weeks off PEP/ 12 weeks post encounter? Is it 100%?
Do I need to test again at the 3 month mark post PEP?
Is the CDC just being overly conservative with testing 3 months post PEP?
I want to put this HIV concern behind me, your help is greatly appreciated.
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Edward W. Hook M.D.
47 months ago
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Welcome to our forum, thanks for your question, and thanks for your confidence in our service. I’ll be glad to comment. Before I comment on your testing, let me remind you that even before consideration of the impact of PEP on your risk for infection, your risk of acquiring HIV, if your partner was infected and untreated ( and you do not know that he was) is less than 1%. Your PEP Would be expected to then reduce that risk much further.
Thanks as well for looking at other threads on our form. We leave them open available for clients so that others can benefit from the information we provide to others. As you have noted, the official recommendation for evaluating the effectiveness of a regimen of PEP is to test with a fourth generation, combination HIV antigen/antibody test six weeks following completion of PEP and then, just to make sure, repeat testing at three months following completion of your medication. We believe that the follow up, three more testing is overly conservative and I am unaware of cases of HIV proven to have converted their test results in the interval between six weeks and 12 weeks following completion of PEP.
At this point I am confident that you did not acquire HIV from your misstep and were I you, I would not pursue further testing related to this exposure. Obviously, whether you test further up to you. I hope the information I have provided is helpful to you. If any part of my response is unclear or clarification is needed, please don’t hesitate do use your opted to follow ups for that purpose. EWH
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46 months ago
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Thanks for the response it was very helpful.
I figure since I have a remaining post I would ask you about some Molluscum I’ve been dealing with for a while now. I believe I originally contracted it in January 2020, almost two years ago now after I was with a cheap sex worker. I’ve been going to the dermatologist for the past 6 months or so to get them burned off with cryotherapy. They seem to keep coming back, it started on my penis and moved to my groin/ down my legs and buttocks area. I think there may even be some spots on my arm now as well. I’ve read that most Molluscum should’ve cleared up on its own by now which leaves me concerned this will be a recurrent problem for the foreseeable future. Some questions I have:
Can I keep self infecting myself with Molluscum resetting the clock, making it longer for my body to clear it up with each new spot appearing?
Can genital Molluscum spread to other parts of my body?
Are there different strains of Molluscum some worse than others that don’t seem to go away?
Can Molluscum be permanent and never go away or will it eventually clear up?
If it will clear up eventually when could I expect my body to rid itself of it?
Is there anything more I can do on my part to help?
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Edward W. Hook M.D.
46 months ago
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Management of molluscum can be challenging. In most persons recurrences do occur but the disease runs its course, most typically over 2-4 years when it finally resolves and stops recurring. The disease is transmissible and can be spread around by scratching, shaving, etc. Do your best to keep lesions covered, work with your dermatologist to treat lesions as they appear and do your best not to scratch or abrade them, despite the temptation and inclination. Thus:
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Can I keep self infecting myself with Molluscum resetting the clock, making it longer for my body to clear it up with each new spot appearing?
See above, Recurrences don't necessarily "restart the clock" but the disease has to run its course.
Can genital Molluscum spread to other parts of my body?
Yes, through scratching, shared razors, etc.
Are there different strains of Molluscum some worse than others that don’t seem to go away?
No that I'm aware of. The infection takes longer to resolve in some persons than others but I think this has to do withthe infected persons, not the virus
Can Molluscum be permanent and never go away or will it eventually clear up?
Typically no. Persons with weakened immune systems such as persons with HIV may have prolonged cases which are difficult to treat.
If it will clear up eventually when could I expect my body to rid itself of it?
See above. 2-4 years. Keep over it
Is there anything more I can do on my part to help?
No that I know of, other than as outlined above. Work with your doctor to address this
EWH
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46 months ago
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Just to clarify, Molluscum is only possibly a permanent issue for immunocompromised people? Since I don’t have HIV and am not immunocompromised my Molluscum will clear itself within a couple years? I just want to be confident my Molluscum will be 100% cleared by the 4 year mark.
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Edward W. Hook M.D.
46 months ago
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Correct. While molluscum is relatively poorly studied, all available data suggests that over time your body will develop immunity to the virus and your molluscum will stop recurring.
As you know, we provide up to three responses to each clients questions. This is my third response. Does this thread will be closed shortly without further responses. Take care. EWH
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