You may be the luckiest person who ever asked a question in the nearly 20 years of this and our preceding forum. Your test results so far indicate you probably did not catch HIV despite a very high risk event. Why did you stop PEP??? There are few exposures as high risk as a shared drug injection needle with an HIV infected person. Compared with that, the sexual event was trivial; the needle event probably was 100 times more likely to result in HIV than the sexual exposure. You appear to have dodged a very big bullet!

That said, you aren't completely out of the woods. You'll need additional testing to assure you were not infected. Ideally you should be in the care of an HIV expert, and you might set up such an appointment now. You need both another RNA test, probably about now; and a final AgAb (4th generation) blood test 6 weeks after the exposure. To your specific questions:

1) I agree with Dr. Hook's advice, as you quote it. I have written the same thing myself several times on this forum.

2) Yes, those results are conclusive. However, you have had just about the highest risk HIV exposure ever reported on this forum. You still should have an AgAb test (4th gen) at 6 weeks.

3) True.

One day of PEP doesn't make any difference. (I'm still sorry you didn't take the full PEP course as prescribed, but very glad things are working out OK!)

HHH, MD

I'm grateful for your advice; thank you! 

The decision to not take PEP was VERY difficult, but I like to think that there was a method to my madness. There was not enough space to write these details in my first post. I have never done drugs, nor had the woman. We had this fantasy of trying that out. She had access to them and brought it with her along with two needles. With I being drunk at the time, I wasn't very deliberate while choosing the needle. Further, I could have never imagined that she may test positive later. After her test result, I started second guessing myself and rushed to ER and asked for PEP. After my anxiety cooled down a little, I found that I had a strong gut feeling that I could not have made the mistake I thought I did of picking the wrong needle. I thought that my anxiety and fear was taking me over in second guessing myself and I decided not to continue with PEP after just one day/dose. I hope I was right. I might not have been exposed after all. All of this might just be a lot of stress for nothing. I hope that I may never know. 

I would like to know why you recommend that I find an HIV expert and get under his care. I mean, at this point, is there anything that can be done? Further, I feel that I already am under you, one of the best experts out there, for guidance for the situation I find myself in. I also am nervous disclosing my adventure that may possibly amount to illegal substance abuse. If you think it's okay for the time being, I will like to follow your guidance until my testing is conclusive.

The incident happened on 21st March. I am in the fifth week now and trying to figure out from your response what my testing plan should be going forward. As mentioned earlier, so far, I have a negative RNA and IV generation result at 3 weeks. Given this, as per one of your conclusive testing guidelines, I was hoping that I would be in the clear with another (hopefully negative) IV generation test at week 4.

However, you seem to suggest that I should have IV generation test at week 6 (and one more RNA in addition to the one I already had?). Is it okay to do both of them 6 weeks past the incidence or are you trying to suggest that I have the RNA now and the combo test at week 6? In short, what is your best recommendation? 

1) RNA now and IV generation at week 6

2) Both of them at week 6

3) Or something else

And would this be conclusive? Or would there be a need, given the level of risk, of going back to the old 3 month window period? Is the 6 week IV generation guidance/window period not "regardless of the risk" kind of conclusive? I have to travel overseas for 3 months for a work assignment on 10th May and I really hope that this is conclusively behind me through a 6 week negative IV generation test before I leave the US..

I will follow whatever your guidance may be to a tee. I hope to use the last response I have to report the good news of negative test results following your recommended testing guidance.

Thanks again for everything!

If in retrospect you are confident you used a different needle that your partner did, then not taking PEP likely was the right decision. If you had any doubt, it should have been continued. Either way, that's water under the bridge at this point.

In general, a negative AgAb test is conclusive 6 weeks after the last potentially risky exposure, or the last dose of PEP. But if there is a serious likelihood you used a drug injection needle after your partner used it, some experts would recommend testing out to three months. This is an important reason this decision should be made by one's only HIV-experienced health care provider. But in the meantime, you can indeed remain confident that it is very unlikely have HIV, based on your latest negative test result.

I forgot to mention that I use steriod dye drops daily, Prednisolone Acetate 1% one drop daily

I will go and seek advice of an HIV expert as per your suggestion. But I would appreciate your opinion on this. I ask this because I see so many things being said. For example, when I visited an urgent care center for testing the health professional there said that it takes 1 year to rule out HIV. I think that is not accurate. But for such reasons, I am requesting your guidance. If you had a patient like me, what would be your advice to him for conclusive testing? Is it biologically possible for someone to have the test results I have and still be infected with HIV?

I thank you for your time and guidance. I feel very grateful, and it is much appreciated!

Prednisolone eye drops make no difference. Indeed, no dose of corticosteroids -- even very high dose systemic treatment -- has no effect on HIV or syphilis test reliability.

No, it is not "biologically possible for someone to have the test results [you] have and still be infected with HIV".

It's up to you whether to go forward with in-person professional evaluation by an HIV expert. I would hope it might help you get to a point of complete understanding and resolve any remaining fears you have about it.

That concludes this thread. I hope the discussion has been helpful. Best wishes and stay safe.