Post-Exposure Prophylaxis: Symptoms and Concerns After Risky Encounter

Post-exposure prophylaxis symptom inquiry

Hello Doctor, I engaged in high-risk sexual behavior with a sex worker on August 31st at noon.
That evening at 7 PM, I immediately registered at the infectious disease department, and at 8 PM, I started taking PEP (post-exposure prophylaxis) with Tenofovir.
However, since last week, I have been feeling a bit feverish, although it hasn't been every day.
Today, I again felt a bit feverish, measuring an ear temperature of 38 degrees Celsius and a sublingual temperature of 37.5 degrees Celsius.
Additionally, from September 16th to 17th, I started developing scattered itchy red rashes and dizziness, with about five or six visible and palpable spots distributed on my calves (3), arms (2), and neck (1).
As of today, September 20th, the rashes on my calves and neck are no longer itchy, but I still feel dizzy.
I researched online and found that if infected with HIV, symptoms could appear in the second or third week, including fever (or low-grade fever), dizziness, and rashes.

I have the following questions:
1.
Is there a problem with my current symptoms? Is there a possibility of treatment failure?
2.
Are there any documented cases of treatment failure with post-exposure prophylaxis at Tainan Hospital or in Taiwan?
3.
Given that it has been three weeks since the exposure (and I have been taking Tenofovir consistently every day), can I get tested anonymously and have it detected?
4.
If the other party is an HIV carrier and is on treatment with Tenofovir, could I develop drug resistance? Thank you.

Huangkong, 30~39 year old female. Ask Date: 2022/09/20

Dr. Hong Yuanbin reply Internal Medicine

Hello,
1.
Your symptoms are more indicative of an allergic reaction or eczema, and it may not necessarily be a treatment failure.
Whether you are HIV positive can only be determined through testing.

2.
The incidence of HIV infection after prophylactic treatment failure is very low, both abroad and in Taiwan.

3.
If, unfortunately, you do contract HIV, it can be detected through testing.

4.
If the other person's virus has no drug resistance, theoretically, if they transmit the virus to you, the virus you acquire would also not be drug-resistant.

Thank you for your question.

Reply Date: 2022/09/20

More Info

Hello, thank you for reaching out with your concerns regarding post-exposure prophylaxis (PEP) after a risky encounter. It’s important to address your questions thoroughly, as they relate to both the potential side effects of PEP and the concerns about HIV transmission.

1. Symptoms and Concerns: The symptoms you are experiencing, such as elevated body temperature, dizziness, and the appearance of a rash, can be concerning. While these symptoms can be associated with acute HIV infection, they can also be side effects of the medication you are taking (in this case, Genvoya, which contains tenofovir alafenamide, emtricitabine, and elvitegravir). It is not uncommon for individuals on PEP to experience mild side effects, including gastrointestinal issues, fatigue, and sometimes mild fever. However, the presence of a rash and persistent dizziness should be evaluated by a healthcare provider to rule out any other causes or complications.

2. PEP Efficacy: PEP is highly effective when taken correctly and within the appropriate time frame after potential exposure. While there have been rare cases of PEP failure, the overall success rate is quite high, especially when the regimen is started within 72 hours of exposure and taken consistently for 28 days. In Taiwan, as in many other countries, PEP is a standard practice, and while there are anecdotal reports of failure, they are not common. It’s essential to follow up with your healthcare provider for ongoing monitoring and support.

3. Testing for HIV: Regarding your question about testing for HIV, it is generally recommended to wait at least 4 weeks after exposure for an initial test, with follow-up testing at 3 months for conclusive results. However, some tests can detect HIV earlier, so it’s best to consult with your healthcare provider about the most appropriate testing options for your situation. Since you are on PEP, it is crucial to continue taking the medication as prescribed and to have regular follow-ups with your healthcare provider.

4. Resistance Concerns: If the individual you had contact with is HIV-positive and is on effective antiretroviral therapy, the risk of transmission is significantly reduced. However, if they are not virally suppressed, there is still a risk. The medications in PEP are designed to prevent HIV from establishing an infection, and taking them as prescribed should not lead to resistance in your case. Resistance typically occurs when the virus is present and replicating in the body while exposed to antiretroviral drugs. Since you are taking PEP, you are not infected, and thus resistance is not a concern at this stage.

In summary, while your symptoms warrant attention, they do not necessarily indicate a failure of PEP. It is crucial to maintain open communication with your healthcare provider, who can provide guidance tailored to your specific situation. If your symptoms persist or worsen, please seek medical attention promptly. Remember, the best course of action is to continue your PEP regimen and follow up with your healthcare provider for testing and monitoring. Your health and well-being are paramount, and timely medical advice is essential in these situations.

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