Hi Dr HHH ,

Need your advice on my exposure .

5 weeks ago i had been to a barber shop and once i came back home i realized there was 2 nicks in the ear and i saw blood  and this was caused by a trimmer . I know for sure that it was not cleaned after the previous customer left .

There should have been at least few  minutes gap before the previous customer and myself . 

Trimmer was sharp and i got worried as it might have caused similar nick in the previous customers . 

So i went to a Physician and he advised me to take a test after 2 weeks . Since i insisted he prescribed me  Truvada for 31 days .

I found it later that for PEP we need to have 2 different tablets one of which is Truvada . So the PEP was not truly "PEP" as it was partially prescribed . 

I completed the course .While i was taking the tablets everyday i used to feel tired for 3-4 hours in the evening .Once i completed the course for 31 days now i don't have that fatigue.

Not sure if this was because of Truvada or HIV symptoms  . 

After that initial exposure , it has been since 6 weeks and completion of PEP has been 12 days  . 

My questions : 

1) How many weeks do i need to leave before i get HIV-1/hiv-2 Ag/Ab test .  At what stage can it be called conclusive .

2) Is there any other HIV test that  can be done sooner and has a shorter window period  and is more reliable so that i can stop thinking about this incident and start leaving peacefully and rather than waiting for 90 days .

3) What are the chances that symptoms that i had was because of Truvada or HIV .

4) I have read in the internet that HIV virus would be active on razor for at least few hours .

If one can get HIV through needles why is it not possible to be transmitted through razor or trimmer or other sharp objects . 

5)What are the long term side effects of Truvada .

Nobody in the world has ever been known (or as far as I know, even suspected) of catching HIV from a shaving nick or other injury during hair cuts, shaves, or other cosmetic events. Even if the prior customer had HIV (which probably is unlikely) and the instruments were not cleaned afterward, there was little or no risk. I would have recommended against even testing for HIV and I agree your doctor was correct in resisting your request for PEP; had you seen me, I also would have refused (and you would not have been successful in talking me into it). In recent years Truvada (a two-drug combination) as PEP usually has been accompanied by a third drug, but not always or in all situations. For over a decade Truvada alone proved to be at least 90% effective in preventing HIV infection. Fatigue alone is not a likely symptom of HIV, but is a fairly frequent side effect of Truvada. And it very unlikely anyone would have HIV symptoms while taking anti-HIV drugs.

To your questions:

1) For the reasons above, you really don't need any further testing at all. However, I understand you will want to continue until you have had a conclusive result. Most experts agree that a negative AgAb HIV test is conclusive 6 weeks after completing PEP, so that's when you should be tested.

2) You can start having AgAb tests around 3 weeks after completing PEP; by that time the result will be ~90% conclusive. Some people seek RNA blood tests for HIV at around 2 weeks, but I really don't think it's worth the effort or cost, since a 3 week AgAb test only a week later will be just as reliable.

3) I cannot say the cause of your symptoms, except it isn't HIV, but Truvada might have been responsible.

4) You can find just about anything you want -- or confirm any fear or worry you have -- with internet searching. The fact is that nobody has ever been known to catch HIV from a sharp instrument injury except health workers injured with instruments that had visible HIV infected blood on them. I am unaware of any reliable data on how long HIV might survive on a razor, but I really don't think it matters.

5) There are few if any long term side effects of Truvada, especially once someone has stopped taking it.

Please do your best to not worry about HIV. Truly there was no significant risk of infection; and even if there were, your PEP would have been effective in preventing it. I hope these comments help you move along without worry. Best wishes and stay safe.

HHH, MD