I've been on PreP for 3 months running. While on PEP on 25/03/23, I had unprotected insertive vaginal intercourse with a female who had tested negative on 21/03/23 on a rapid test kit. She claims she had last tested in October 2022 and has never had unprotected intercourse since then...until we did. She has been a long term friend and I'd want to trust her but, I can never be so sure...which is why I'm on PreP.

After the event, I continued with my daily PreP until now. I missed a dose the 6th day after this encounter but resumed as soon as I remembered the following day. This is the only time I missed a dose in the 3 months. 

Exactly 10 days after the event, I had a sore throat for 2days that went away after taking OTC relievers. It went away for 4 or 5 days and resurfaced. This time I took an antibiotics course which i did not finish and it went away for 5 more days. It re-surfaced again and I've been taking home remedies to help it. Some days I don't feel it, some days I do. When I do, it's worse in the morning. Accompanied with it is a constant urge to clear my throat and spitting out phlegm. I eat and drink normally with no pain but I feel the discomfort when I try to swallow my saliva. I cough here and there. 

I also must mention that my family members have also had sore throat issues in the same time but mostly with coughing and blocked noses. 

Could this be ARS? Considering that she was on the window period. I tested with a lab antibody only test 3 days after the initial sore throat and it was negative. I tested again yesterday with a rapid antibody kit and it was negative. 

Should I go for a 4th gen test or it's unlikely I could have been infected from the encounter?

It is not possible to have symptoms due to HIV (i.e. acute retroviral syndrome or ARS) while taking anti-HIV drugs. Missing a dose makes no difference in its effectiveness. Even if you were not on the PEP drugs, I would have advised there is no realistic chance your symptoms are due to ARS. We're in the middle of cold and influenza season; covid still is frequent; and you allude yourself to others around you with similar symptoms. These problems must be at least 10,000 more common than ARS, even in people with real exposure and high risk, which you do not have while taking PrEP. Also, ARS doesn't cause cough; and sore throat usually is not the only ARS symptom. You caught a cold; and you should test yourself for covid.

There is no point in you testing for HIV at this time; you could not have been infected. Even if there was a chance of infection, you cannot have a valid HIV test until you have been off PEP drugs for six weeks. 

Turning to something mentioned by Dr. Hook:  I don't understand why you're on PEP. With only female partners, your risk of HIV is exceedingly low -- not high enough for PEP, in my opinion, with the inconvenience of 4 weeks treatment each time. Even with only a few non-monogamous exposures, you'll likely need to be on treatment most of the time, in which case PrEP makes more sense. And Dr. Hook mentioned PrEP "on demand":  it requires only 3 days of antiretroviral drugs, starting shortly before a high risk exposure and continuing two more days. Doesn't that make more sense? You might discuss it with your doctor.

Finally, I hope you don't mind another mini lecture:  How in heaven's name do you reconcile both being on PEP and yet having UNPROTECTED sex with commercial or casual female partners? With female partners, condoms alone are all you need -- but even without them, you might discuss on demand PrEP with your doctor.

I hope these comments are helpful, even if you weren't expecting a lecture! Best wishes and stay safe.

HHH, MD

I also agree that On-demand Prep is a good idea for me. Your unexpected lecture was much needed and has me avoiding intercourse until I find a stable partner again. The encounter I mentioned was the last until now.

I did continue with the Prep/PEP until Sunday 30 April. I had finished the prescription. On the 22nd of April I had taken a 4th gen test which was non reactive, proving further that my symptoms were not due to ARS. 

3 days post Prep/PEP I’m generally well with intermittent mild muscle aches particularly in my butt muscle, upper arms and the neck. Given my aforementioned exposure, would you recommend further testing 6 weeks post Prep/PEP?

I plan on switching to on-demand prep if I have to have intercourse plus condoms. Thanks once again for your services. 

We do not give specific treatment or diagnostic advice; that comes too close to providing medical care from a distance, which we cannot legally do. Our information is for general purposes; exactly when and whether you might have follow-up testing should be between you and the provider who prescribed your PrEP/PEP. All I can say is that 3 days after completing treatment is too soon to be meaningful, and most experts would indeed advise final conclusive testing in this situation 6 weeks after the last dose of anti-HIV drug.

Thanks for the thanks; I'm glad to have helped.

Thanks.

As you expected, that concludes this thread. Best wishes and stay safe.