Hi. Again, thank you so much for this forum for our doubts.

I would like an assessment on my exposure risk and chances on being HIV positive. My situation is as follows: 11 days ago, I had a MSM, unprotected encounter. I was the insertive partner. I was inside for < 4 minutes. Heat of the moment thing (Very stupid.) The guy tells me he’s HIV positive, has been undetectable for 3 years (accordingly) and is taking Dovato. I decide to go to the ER that same night. I receive PEP (Truvada and Dolutegravir) less than 2 hrs post-exposure. I am started on Truvada daily and Isentress BID. My PCP barely saw me today and ordered an ELISA test (this is day 11.) Negative. I do understand accuracy of the test is sacrificed when taken too soon. But knowing all I said, what are my chances of being positive and seroconverting? 

Thank you for your time and response. 

I don't see any questions here that were not discussed last week. To repeat:  your partner very probably is non-infectious, i.e. zero risk of transmission. If we assume his anti-HIV treatment isn't working and he has a substantial viral load, the average transmission risk for a single episode of insertive anal sex has been calculated (by CDC) at around one chance in a thousand. As you already know, I would have recommended against PEP in this circumstance (so would Dr. Hook). But if we assume your partner in fact had a substantial viral load and that PEP has around 90% effectiveness, the odds you are infected would still be no higher than 1 chance in 10,000. My actual belief is that there is no chance you have HIV. Either way, your negative blood test at 11 days means nothing one way or the other. Well under half of newly infected persons have positive antibody or antigen-antibody tests by that time.

Additional comment, added 4 hours after the rest of my reply above: HIV test results (ELISA or other technologies) can remain negative while taking PEP, even if PEP fails to prevent HIV infection. Therefore, the clock for valid HIV testing starts when PEP is completed, so you will need testing with an AgAb test out to 6 weeks after the last dose. (One of the downsides of PEP, and one of the reasons I would have counseled against PEP in this situation, is the delay in conclusive test results, which often prolongs anxiety and worry about the outcome.)

HHH, MD