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Q. How accurate is the 4th generation HIV antibody test 30 days after exposure?

Answered by
Dr. Bharatesh Devendra Basti
and medically reviewed by Dr. Preetha J
This is a premium question & answer published on Dec 01, 2021

Hello doctor,

I had a possible HIV (human immunodeficiency virus) exposure risk about a month and a half ago. Although the individual said they recently tested negative three weeks before and were on PREP (pre-exposure prophylaxis). I did not know them that well. I am circumcised and was the insertive partner, unprotected sex. Out of precaution, I got on PEP (post-exposure prophylaxis) 36 hours later, a 28-day cycle. They said I was at low risk. I got a fourth-generation combo test two days after finishing my cycle of PEP, so 30 days after exposure. I came back negative. How accurate would you say this result is? Would the PEP impact the window period? I have a lot of anxiety and depression, thinking about retesting again in two days (48 days after potential exposure). Thanks.

#

Hi,

Welcome to icliniq.com.

Thank you for the query. It is good that it is negative after one month of PEP. The chances of HIV tests coming positive later are very low. But it is better to go for an HIV (human immunodeficiency disease) antibodies test after three months of exposure. No need for HIV tests now. It is likely to come negative.

Hi doctor,

Thank you for your reply.

I would prefer not to wait three months for a definitive result if that is possible. Also, in your experience, has anyone who has taken PEP later tested positive after testing negative? Assuming they did not have any other future exposures and adhered to the protocols correctly.

#

Hi,

Welcome back to icliniq.com.

Thank you for the follow-up query.

Suppose PEP is initiated as early as possible and the medications have been taken according to recommendations. In that case, there are very few positive cases reported after PEP, especially in those with inappropriate or delayed PEP. In your scenario, partners have also been initiated on PREP. So an added advantage too. HIV test has come negative after one month PEP is a good sign. To have conclusive results, you need to go for tests after three months. The chances of HIV tests coming positive later is less to almost nil. But you need to wait.

Hello doctor,

Thank you for your reply.

I started about 36 hours after exposure, and I took every dose on time. I am taking Truvada (Emtricitabine / Tenofovir) and Isentress (Raltegravir). What do you mean by inappropriate or delayed? I hope so, but I am not sure. I grilled them about it, but in hindsight, I should have never trusted a stranger. I have attached a picture (attachment removed to protect patient identity) of my hand. I have been getting rashes like this when I was on the PEP and while off. Like bumps with raised lines. Have you seen anything like this before? It comes and goes in various places on my body. I stopped my Lamotrigine and Buproprion a couple of days ago to see if that could be the cause. Fine, as hard it is, I guess I will. I am scared to death.

#

Hi,

Welcome back to icliniq.com.

Thank you for the follow-up query.

Some do not complete the PEP course. Or start late after 72 hours or 60 hours. In your scenario, it is 36 hours. They are on PREP and may be HIV negative too. Your post-one-month test is negative. So relax. The rash may be due to some allergy or urticaria, or drug. These are dermographism (lines). You follow up with your dermatologist if it persists. It can occur due to any allergies but does not relate to HIV. Just relax. Forget the episode for now. Get involved in activities of your interest. Do yoga, meditation, and exercises. Go for HIV tests after three months.


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