Good day doctors

First of all, it is a honor to communicate with you. I would like to ask some questions related to my case and some other related to better understand how HIV works.

So, 46 days ago I had protected oral, vaginal, and anal sex with an expensive sex worker from western europe (This is the only time that I have ever done this). She was very careful putting the condom on and we even used lube. By the end of the act, the condom seemed to be ok, but I couldn't check for any small tears  or breaks (something that I always do). Since this moment, my anxiety became to increase and I went to the hospital to get PEP (which the doctor did not recommend) and a full STD panel test, which all came back negative.

On day 21 after the potential exposure, I got tested with a RNA Test for HIV-1 which came back negative (not detected) and on day 29 after the potential exposure, I got tested with 4th generation Ag/Ab test and  RNA Test for HIV-1, which came back again negative (non-reactive and not detected, respectively). My questions are:

1) Are these tests conclusive? Despite having some "symptoms" such as a dry cough after 5-7 days of performing the tests.

2) I would like to get vaccinated against Hepatitis B and HPV, but I am not sure if I'm still eligible for the vaccines: I've read it's only for people not older than 26 years and I'm 27.

3) I was reading the academic paper that I think the CDC used for its current recommendations (https://academic.oup.com/cid/article/64/1/53/2194435) and it got my attention that the simulated eclipse period could last until 33 days after the exposure to HIV. Although theoretically it is possible as shown in the paper, have you ever heard/read/seen an eclipse period lasting more than 3 weeks?

4) Is the scientific community any close to a cure/vaccine against HIV? Why has it been so hard to cure/eliminate this virus?

Thank you very much for your time

Sorry, I meant a sex worker from eastern europe...

Welcome to our Forum.  Thanks for your questions.  Even before testing this was a low risk event.  Most commercial sex workers do not have HIV, most exposures to infected untreated partners do not lead to infections, and condoms are highly effective for prevention of HIV.  FYI, checking condoms following use is not needed.  When condoms fail, they break wide open leaving no doubt that they failed.  As long as the condom appeared intact, it did not break.  Further, as explained below, your tests prove that you were not infected.  I see no need for further testing or concern.  Regarding your specific questions:

1) Are these tests conclusive? Despite having some "symptoms" such as a dry cough after 5-7 days of performing the tests.

Your results are conclusive.  HIV RNA PCR tests are thought to be conclusive at any time more than 11 days following an exposure and while experts suggest a follow-up HIV antigen/antibody test 6 weeks following the encounter to be sure, we have never seen nor heard of a person with a negative PCR test at more than 11 days who went on to become positive.  Your 29 day further proves you were not infected.  The tests prove that the symptoms you experienced were not due to HIV- if your symptoms were due to HIV, the tests would be positive.  Also, FYI, cough is NOT a symptom of recently acquired HIV.  

2) I would like to get vaccinated against Hepatitis B and HPV, but I am not sure if I'm still eligible for the vaccines: I've read it's only for people not older than 26 years and I'm 27.

You can certainly get vaccinated for both HIV and hepatitis B.  Here in the U.S. HPV vaccine is now recommended for persons up to age 45.  The hepatitis B vaccine is likelwise recommended.  Your insurance may or may not cover the cost of the vaccines but I encourage you to pursue them.

3) I was reading the academic paper that I think the CDC used for its current recommendations (https://academic.oup.com/cid/article/64/1/53/2194435) and it got my attention that the simulated eclipse period could last until 33 days after the exposure to HIV. Although theoretically it is possible as shown in the paper, have you ever heard/read/seen an eclipse period lasting more than 3 weeks?

This is conjecture.  There are no proof or data to suggest that the so called window prior to developing a positive PCR test is more than 11 days

4) Is the scientific community any close to a cure/vaccine against HIV? Why has it been so hard to cure/eliminate this virus?

The virus is hard to deal with because the viral DNA get intermixed with the DNA of living human cells.  Work continues both on development of cure and an effective vaccine but there is no vaccine or cure at this time

Please do not worry.  I encourage you to move forward without concern.  I see no reason for further testing.  EWH

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Thank you very much for your answer, Dr Hook.

I didn't know that a PCR and 4th gen test together at 4 weeks are considered conclusive, and I was worried because I knew I tested during the window period according to the CDC. (in a way, I was obsessed that I had 4 days left to finish the window period, at least for NAT, and that in those remaining days the result could change).

Hello Dr Hook, hope everything is going well. I would like to ask you a couple of questions (they may be one, actually):

Thanks for your follow up questions:---

Yes, your tests are conclusive.  FYI, hepatitis C is not an STI.  Tests for gonorrhea and chlamydia are typically reliable within 3-5 days after an exposure.  Tests for syphilis and hepatitis B are typically positive in less than a month after exposure.  I would be comfortable that these tests rule out having acquire an STI from the exposure you describe.  I see no need for further testing.  It is time to move forward without continuing concern over the exposure you have described.  ---