In response to your last reply in the last thread, yes I understand the need to change my sexual behaviors since the use of PEP is not a long-term solution. I think after this time I will just try to find a stable girlfriend/partner to avoid all these problems.

Anyways my last exposure which I am still on PEP for was on February 10, the other partner actually just messaged me two days ago and showed me a test result where she tested for HCV, HIV, Syphillis, and all were negative. However, her HIV test I believe was  just an antibody test because in the picture it looked like a COVID test kit with the label "1/2 Ab" on it. 

Another thing is that I have noticed my throat becoming a bit tight in the past few days, I wouldn't say it's a sore throat as I've had tonsilitis before and this doesn't feel like that. It doesn't hurt when I swallow but my palatoglossal arch is a bit red. I do have post nasal drip so I always snort to clear the mucus I feel is in the back of my throat which I read online can also affect this throat tightness. Anyways I just wanted to ask if there was any concern of ARS in this situation. Also when ARS is present does it usually just manifest in one symptom or is it a combination of the listed "flu-like" symptoms?

You are seriously overthinking all this. There is zero risk you have HIV. You simply cannot be infected with HIV while taking antiretroviral drugs for PEP from your previous exposure. You also cannot have symptoms due to HIV from the previous exposure; even if PEP doesn't work, there is no possibility of symptoms until after you stop taking PEP. And your symptom are not suggestive of ARS anyway (it doesn't cuse nasal congestion or post nasal drip, for example). Undoubtedly you have a garden variety minor cold, nothing more. (Or Covid-19; consider testing for it.)

From a sexual safety standpoint, I support your hope and plan for a committed, ongoing relationship. Until that happens, I recommend always using condoms for vaginal or anal sex (not necessary for oral sex); NOT testing your partner or yourself for HIV every time you have a new partner; and NOT getting PEP for every new partner you have. Instead, plan on having an HIV test from time to time. If you have new female partners say once a month, then consider testing every 6 months or so; if less frequent partners, then once a year probably would be sufficient. At the time of each HIV test, I would also advise a syphilis blood test and urine tests for gonorrhea and chlamydia -- but no tests for any other infection. The chances are too low and many of the other tests offered by many labs are not reliable in people without symptoms.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

Also for the ARS it’s not that it’s causing me post nasal drip I just meant to ask if my throat issues were a symptom of ARS. I already have a post nasal drip condition that I read can also cause this throat symptom but just wanted to ask and be sure. Since you say ARS does not occur while on PEP then this is probably just a symptom of my sinus and PND conditions. Also Dr. you didn’t answer the question about how ARS manifests, does it usually just show as one of these “flu like” symptoms or is it usually a combination of several symptoms? Say somebody just had lymph nodes or just had rashes but nothing else would this usually be indicative of ARS or is it usually the entire slew of related symptoms showing at around the same time that determines ARS. 

And Dr. your diagnosis of my case is there is no risk of HIV contraction? If that’s the case should I just end my PEP now and do some type of conclusive testing soon instead of waiting 4-6 weeks from March 10?

Thanks 

Please go back and carefully re-read all my replies to date, in both your previous thread and this one. I will not respond to repeat questions or to questions whose answers are obvious from our discussions up til now.

So my throat situation hasn’t gotten better and it’s been two weeks. I saw a clinician and they said it could also be a side effect of PEP and gave me ibuprofen which I completed taking but it hasn’t gotten better but it also hasn’t gotten worse, so I wanted to ask you if his explanation was possible. Again I don’t have any pain swallowing, just the top of the back of the mouth feels a bit tight and my palatoglossal arch is still red.

 So my PEP will end this coming week and I will go in for baseline testing first and then test again after 4 weeks since that’s what the doctor here arranged. Will this baseline testing assure that my symptoms are not ARS if I test negative? I read in your forum that those who show symptoms of ARS will test positive for it since symptoms means you’re basically already infected. 

I also read through some of your forum answers and in one of the questions you said that baseline testing after PEP ends is 98% conclusive? Does this mean that from a data perspective that 98% of people who tested negative after finishing PEP ended up testing negative at the next testing date? I also read online that conclusive testing for PEP users can be as soon as two weeks post PEP? Im not sure why there seems to be so much variation in the cited sources and recommendations about window testing so I wanted to ask you the reasons. I understand that every case is a case by case basis so perhaps that’s why the testing recommendations for patients can differ too. 

I don't think I ever said testing immediately after completing PEP is 98% conclusive. It is not. It becomes ~98% around 4 weeks after the last dose, probably 100% after 6 weeks. A megaton test at 2 weeks is probably about 90% certain. But that sometimes is enough. If the chance you caught HIV is say one chance in a million and a test is 90% conclusive, then with that negative result the chance you have HIV becomes one chance in 10 million, which you can consider zero. And even one chance in a million probably is too high a guess at your risk.

That concludes this thread. Please note the forum does not permit repeated questions on the same topic or exposure. This being your second, it will have to be your last on these exposures, PEP, and HIV testing. Such repeated questions are subject to being deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers; because experience shows that continued answers tend to prolong users' anxieties; and because such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand.