The infectious disease specialist I seen said all my blood work was excellent! I’m waiting on a 2nd test currently 28 days post pep

Your wording is confusing. But I think I understand you took post exposure prophylaxis against HIV after an exposure, that you tested negative for HIV about 2 days after finishing that treatment, and now are wondering whether your upcoming test result -- 28 days after finishing PEP -- might be positive. Is this about right?

An accurate answer requires more information. Please say more about the exposure and your partner. Vaginal or anal sex? Oral sex? Whose penis was in whose vagina, rectum, or mouth? Your sex and whether your partner is male or female? Is your partner known to have HIV? If not, what are his or her risk factors -- male having sex with other men? Injection drug use? And so on.

Regardless of that information, it sounds like your ID specialist doctor believes there is little chance you have HIV. Even if your partner was infected and you had a high risk exposure, most exposures to HIV do not result in transmission. (People can have sex hundreds of times with infected partners and not become HIV positive.) And PEP is highly effective. So it seems to me it is unlikely you caught HIV. Therefore, it seems likely you will continue to test negative. A negative test result 4 weeks (28 days) after completing PEP will be very reliable, but not yet conclusive. In other words, a negative result will be very reassuring, but not proof. The AgAb (4th generation) HIV blood tests require 6 weeks after completing PEP to be conclusive.

With the limited information you have provided, it seems unlikely you have HIV. But I will be happy to comment further if you would like to provide the missing information, then we'll see how things stand. In addition, you might discuss this issue -- and my comments -- with your ID specialist, for her consideration.

HHH, MD

It is rare for a negative result 28 days after completing PEP to later become positive, but not impossible. Exact data are not available, but all experts recommend final testing at least 6 weeks after the last dose, and some might recommend 3 months. You probably had a high risk exposure, especially if your HIV infected partner was not taking HIV treatment. If he is taking effective treatment with an undetectable viral load, you were at little or no risk and PEP would not normally be recommended. So I assume he is not on treatment. It also is unclear whether you were bottom (highest risk) or top (lower but still high risk) for unprotected ("raw") anal sex.

The bottom line (pun intended!) is that almost certainly you did not catch HIV. But to be 100% certain you should have another AgAb test at least 6 weeks after your last dose of PEP.

As I have already suggested, I could more accurately advise you about these issues if you can tell me whether you were the insertive (top) or receptive (bottom) partner in the anal sex event; and, if you know it, whether your HIV infected partner is taking anti HIV drugs and whether his viral load is detectable or not.