Giving more info on my exposure: this girl intentionally pulled my skin down so there was one small cut on my penis frenulum. I am uncircumcised man. I was drunk and I only noticed it after finishing unprotected intercourse after seeing lot of blood, there may be blood from her vegina also because it was too much blood stains. And it was still bleeding from my penis frenulum after I finish intercourse. I came outside, not in vagina. So considering her viral load which I checked after 11 days (51 copies/ml, test detection limit was 20), I consider it high risk. She also took one medicine that evening which i didn’t ask which medicine. Her 4th generation was negative so may be she was on some ART medicine or PEP.

Pls help me.

The opening lines of your question appear garbled and I'm not sure I entirely understand the nature of the exposure, but I think I understand enough -- especially in view of your symptoms and your own test results -- to give you a very reassuring reply. You do not have HIV.

If indeed your partner's HIV testing is valid, from a virological perspective it was low risk. An RNA (viral load) result of 51 copies is extremely low number, probably too low for transmission. But her negative AgAb (4th generation) HIV blood test strongly suggests her RNA result is false positive. In theory, she could have had very early HIV infection, probably under 2 weeks duration -- but even in that case, her low RNA result probably is non-transmissible. When infected people are on effective ART, indeed it lowers the viral load, but effective treatment has no effect on HIV AgAb test results, which remain positive for life regardless of treatment. And so regardless of your exposure with a fresh bleeding injury of your penis, I would consider this a low risk exposure. In addition, PEP is highly effective when started within 72 hours of exposure. (You don't say what that interval was.)

But perhaps most important, your own test results are extremely reassuring. It appears your exposure has been managed by a legitimate HIV expert:  many providers would not have known to test for proviral DNA, for example. That result plus your negative AgAb result 35 days after completing PEP probably is conclusive. That said, some experts recommend final HIV testing a full 6 weeks after the last dose of PEP, and some even advise three months. However, considering all factors -- that your partner probably was not infected, her low viral load if she was, your completion of PEP drugs, and your post-PEP test results -- there is no realistic chance you have HIV. You can safely have unprotected sex with your wife.

Finally, your symptoms can be disregarded in relation to HIV. The symptoms of ARS are not caused by the virus, but by the immune response to it. Therefore, it is not possible to have symptomatic ARS in the face of negative antibody testing. That is, your negative AgAb test result proves HIV is not the cause of your recent or any current symptoms. In addition, I have never heard of musculoskeletal pain as the main or only symptom of ARS. Something else explains your muscle and joint pains.

My guess is your doctor has given you similar reassurance. But I do hope these comments are helpful and reassuring. Let me know if anything isn't clear.

HHH, MD

anyways from your reply I understand you didn't get my 2nd msg where I mentioned in detail about my exposure please see again as below (pls don't count it as follow up msg hence)-

2) This makes no difference in my assessment of your situation.

3,4) As I said above, it is not possible to have HIV symptoms in absence of HIV antibody and other evidence of HIV infection. You do not have HIV; something is the cause of these problems.

5) You have already had completely conclusive tests. I am aware of no other tests you could possibly have.

6) Whatever "danger" there was of HIV at the time of exposure no longer matters, because it has been proven you do not have HIV.

Thanks for your quick reply.

I am sorry but I expected detailed reply as I have listed down so many things and some questions were not answered specially testing time after pep. Pls try to give detail reply. I am sorry from my heart but I need this.

Also pls give me hiv testing conclusive guidelines after PEP for HIV DNA/RNA testing (I also asked which test better in DNA and RNA). Pls I want to keep safe my wife and children and I need to do family planning for my 2nd child. I hope you understand my situation at the moment.

There are no "conclusive" guidelines for testing after PEP, i.e. no official agencies have published or otherwise promoted conclusive guidelines. However, most experts do not use genetic (RNA/DNA) testing, only AgAb tests. Most agree that those results are nearly conclusive 4 weeks and truly conclusive 6 weeks after the last dose of drug, but some recommend testing a final time at 3 months.

That completes the two follow-up questions and replies included with each question and so ends this thread. If you remain concerned or uncertain, I would advise you to go back and re-read all my replies, carefully. If still concerned after that, ask the doctor or clinic where you received your PEP. Most likely they are equally expert as we are on this forum.

Even though you obviously doubt our expertise or knowledge, I hope the discussion has been somewhat helpful. Please understand you do not have HIV. That's all that matters, right? Good luck to you.