[Question #9013] Testing and Pep
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37 months ago
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Hi experts. I had sexual vaginal exposure in May 2022. The guy's condom broke and I subsequently noticed I had visible fluid on me. I then took PEP which started around hour 39-48 Isentress and Truvada for 28 days. I had a negative 4th gen test at 4, 6, and 8 weeks post exposure. I also took aptima qual rna at 2 weeks and 5 weeks post exposure which were negative ( I realize the rna test can be impacted by pep or prep). I had a negative INSTI point of care test at 9 weeks and two days post exposure (today). I retested with a 4th generation lab draw test at 9 weeks and 0 days but the results are not back, they are taking longer than the usual turnaround time of 1 business day which is making me quite anxious.
1. When is the testing conclusive?
2. How accurate and reliable are the tests I have had thus far?
3. I am anxious concerned the lab is taking longer than normal and that this indicates something regarding my testing?
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Edward W. Hook M.D.
37 months ago
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Welcome to our forum. Thanks for your question as well as your confidence in our service. I’ll be glad to comment.
Before I comment on your test results let me tell you that your risk of infection from the encounter you describe was vanishingly low. You don’t mention your partner’s HIV status but unless you know otherwise the likelihood that she had HIV was less than 1%. In addition, the likelihood of acquiring HIV if she happened to have untreated HIV infection is less than one in 1000. Put another way in all probability your risk of infection even before you started to take PEP was less than one and 100,000.
After completion of PEP it is recommended that persons have follow up HIV testing 4 to 6 weeks after completion of their pep. From the sounds of things you have been tested at five weeks following completion of PEP. If that is the case, I would urge you to consider your results, which I anticipate will be negative, as conclusive. With that that, addressing your specific questions:
1. See above. Your testing at five weeks is conclusive.
2. Very reliable
3. Given your earlier test results I would be flabbergasted if your test now became positive. I suspect the delay in getting your test results represents some logistical issue at either the laboratory or the testing centers results desk.
Please don’t worry. EWH
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37 months ago
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Oh to clarify it was receptive vag meaning I am the girl. I noticed condom broke and fluid toward the end. Probably men usually post on this forum but this is a woman. Can you please respond with this information in context?
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Edward W. Hook M.D.
37 months ago
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I apologize for my mistake regarding your gender. Despite that era, you can be entirely confident in your test results.
When you were test results return, and I anticipate that they will be negative, please believe them. I see no reason for additional testing. EWH
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36 months ago
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Hello experts. My testing came back negative using a 4th generation lab draw test at both 10 and 11 weeks. Since 11 weeks I have developed runny nose, cough with and without sputum. I am concerned this could be seroconversion. (I do have two roommates who have had upper respiratory symptoms for a couple of weeks, including one roommate with flu A as of yesterday. ) However, I remain concerned about my testing and will get a 4th generation test at 12 weeks and four days.
Have you or your colleagues ever seen or heard of someone seroconverting after having negative tests including negative testing up to 11 weeks point?
Do I need to wait more months or even six months?
Can you further comment on your expert opinion on conclusive results 6 weeks after pep vs CDC and NCCES recommending 3 months?
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Edward W. Hook M.D.
36 months ago
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Final responses:
Your 10 and 11 week results are conclusive. Organizations such as the CDC are, by definition, conservative and take stances using the rationale that the "cannot afford" to be incorrect. Your exposure was low risk and your PEP reduces you likelihood of infection still further even before you tested. Your test results confirm that you were not infected with HIV.
As far as your runny nose being a sign of seroconversion, cold-like/uri symptoms are not typical of HIV seroconversion. You have an excellent and far more likely explanation for your symptoms. If you were seroconverting, your follow-up test, while not needed in my opinion, would be positive at 12 weeks and 4 days. Symptoms are due to the presence of the virus and the immune response to infection, both of which are detected by the tests.
Neither of us has ever seen or heard of someone going on to seroconvert after negative tests up to 11 weeks. You are not going to be the first.
This completes this thread. Please don't worry. EWH
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