Post-Exposure Prophylaxis (PEP) Testing and Results

Post-PEP Testing

Hello Dr.
Hong, I engaged in sexual activity on March 17, which included approximately 30 seconds of unprotected oral sex and about 1 to 3 minutes of protected vaginal intercourse.
During the intercourse, the condom did not fit well, and upon withdrawal, only the tip of the penis and the glans were covered by the condom along with the semen.
I felt anxious afterward and started taking post-exposure prophylaxis (PEP) within 66 hours.
I completed 4 weeks of PEP on April 16 and have undergone the following tests:
1.
At 8 weeks post-exposure (4 weeks after completing PEP), the RT-PCR test showed 20 copies/ml ---> negative (not detected).
2.
At 10.5 weeks post-exposure (6.5 weeks after completing PEP), the 4th generation ELISA test for P24 antigen/antibody ---> negative.
My infectious disease doctor mentioned that the RT-PCR test at 4 weeks post-PEP is very accurate, and that the drug's effects diminish quickly after stopping, thus not affecting the accuracy of the test.
Additionally, since I tested negative on the 4th generation ELISA for P24 antigen/antibody, he concluded that the test results are reliable and that I can be considered to have ruled out infection.
However, I still have some symptoms that worry me, such as mild fever (ear temperature not exceeding 38°C, around 37-37.3°C), night sweats, diarrhea, and I recently felt some discomfort in my throat.
The doctor believes these symptoms are likely due to my anxiety.
I would like to seek your professional opinion, Dr.
Hong.
Can I truly rule out the infection? Is there a possibility of different outcomes in the future? Thank you for your professional assistance.

K, 20~29 year old female. Ask Date: 2018/06/04

Dr. Hong Yuanbin reply Internal Medicine

Hello, based on your description, you have completed PEP and subsequent tests have returned negative.
Unless you have had further relevant exposure, the likelihood of contracting HIV is indeed very low.
As for the symptoms you later described, such as fever, night sweats, and diarrhea, they could be attributed to psychological factors or subsequent cold or other infections.
Thank you for your inquiry.

Reply Date: 2018/06/04

More Info

Post-Exposure Prophylaxis (PEP) is a critical intervention for individuals who may have been exposed to HIV. It involves taking antiretroviral medications within 72 hours of potential exposure to reduce the risk of HIV infection. In your case, you began PEP within 66 hours after a sexual encounter that involved both oral and vaginal sex, which is a proactive step.

Your testing results are encouraging. The RT-PCR test you underwent at 8 weeks post-exposure and 4 weeks after completing PEP showed a negative result (not detected), indicating that there was no detectable viral load in your blood at that time. This is a strong indicator that you have not contracted HIV, especially since RT-PCR is highly sensitive and can detect the virus earlier than antibody tests.

Furthermore, the negative result from the 4th generation ELISA test (which detects both HIV antibodies and the p24 antigen) at 10.5 weeks post-exposure further supports the conclusion that you are likely HIV-negative. The combination of these tests provides a comprehensive assessment of your HIV status.

Your infectious disease doctor’s reassurance that the RT-PCR result is very accurate post-PEP and that the timing of your tests does not affect their reliability is consistent with current medical understanding. Generally, if both tests are negative, the likelihood of HIV infection is extremely low.

However, it is important to address your ongoing symptoms, such as mild fever, night sweats, diarrhea, and throat discomfort. While these symptoms can be associated with anxiety, they can also be indicative of other infections or conditions. It’s not uncommon for individuals who have undergone PEP to experience anxiety-related symptoms, especially after a potential exposure to HIV. Stress and anxiety can manifest physically, leading to symptoms that may mimic those of an actual infection.

That said, if your symptoms persist or worsen, it is advisable to follow up with your healthcare provider. They may recommend further evaluation to rule out other potential causes of your symptoms, including other sexually transmitted infections (STIs) or viral infections.
In terms of future risk, while your current tests are reassuring, it is essential to continue practicing safe sex to minimize the risk of HIV and other STIs. Regular testing and open communication with sexual partners about health status are also key components of sexual health.

In summary, based on the information provided and your test results, it appears that you can reasonably conclude that you have not contracted HIV from the exposure in question. However, ongoing symptoms should be monitored, and further medical evaluation may be warranted to ensure your overall health and peace of mind. Always consult with your healthcare provider for personalized medical advice and follow-up care.

Similar Q&A

Assessing HIV Infection Risk After PEP: Testing Recommendations Explained

Hello Doctor: I would like to ask about a previous high-risk exposure (due to a condom break). I urgently started post-exposure prophylaxis (PEP) within 24 hours and completed the full 30-day regimen. On the 14th day after finishing the medication (47 days post-exposure), I had a...

Dr. Hong Yuanbin reply Internal Medicine
Hello, based on your description, if both the COMBO and RT-PCR tests are negative and you have already taken preventive medication, the risk of HIV infection is indeed very low. If you still have concerns, it is advisable to undergo a retest in 4-6 weeks. Thank you for your inqui...

Impact of Delayed Blood Test Results on HIV Exposure Risk After Needlestick

During surgery, I was accidentally punctured by a brand new needle, which immediately drew blood. However, my gloves had already come into contact with the patient's blood. Blood was drawn in the hospital after the needle stick, but the test results will not be available for...

Dr. Lin Wufu reply Internal Medicine
Hello: There is no immunoglobulin available to prevent HIV, but there are oral post-exposure prophylaxis (PEP) medications. It is recommended to first inquire verbally or check cloud-based records to see if the patient has any bloodborne infectious diseases. If it is confirmed or...

Understanding HIV Transmission Risks After PEP: Key Insights

I started post-exposure prophylaxis (PEP) with Biktarvy 38 hours after high-risk exposure to HIV. However, 44 hours after the exposure, which is 6 hours after starting the medication, I engaged in unprotected sexual intercourse with my ex-girlfriend. My initial intention was to a...

Dr. Cai Zhuorong reply Urology
The situation you described does have a low chance of transmission. However, there are no specific reports in the medical literature providing clear data, as such experiments cannot be conducted. It is advisable to maintain safe sexual practices and to have your girlfriend underg...

Understanding PEP: Effectiveness, Testing, and Oral Exposure Risks

Hello Dr. Hong, I would like to ask a few questions. On October 29 and 30, I performed unprotected oral sex for only a brief period of two to three minutes, without ejaculation in the mouth or swallowing prostate fluid. Afterwards, I rinsed my mouth with clean water. On October ...

Dr. Hong Yuanbin reply Internal Medicine
Hello, 1. It should not affect the efficacy of the medication. 2. The accuracy is high; as long as you have not engaged in any unsafe behaviors during this period, it should be reliable. 3. The chance of infection is very low. 4. Yes. 5. It falls into the moderate to high-risk ca...