Can 17 doses of PEP delay HIV detection in a 4th-gen test?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hello doctor,

I tested negative for HIV (human immunodeficiency virus)-1 & 2 using a fourth-generation test on day 22, day 27, and day 35 after the first exposure. I was immediately placed on PEP (post-exposure prophylaxis), due to a second exposure, which occurred after a month. I completed 17 doses of PEP and then discontinued it. My second contact partner tested negative for HIV. I tested negative via a fourth-generation test on day 33 and day 60 post-PEP, which equates to 112 days post my first exposure.

My question is: can 17 doses of PEP delay seroconversion if exposed and not be detected on tests for HIV-1 or 2?

Kindly help.

Answered by Dr. Basti Bharatesh Devendra

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

If an HIV (human immunodeficiency virus) antibody test conducted in a reliable laboratory after 90 days from the last risky exposure yields a negative result, then it is considered conclusive, provided there have been no further risky exposures. According to protocol, even if PEP (post-exposure prophylaxis) is taken, the test is considered conclusive after 90 days from the last risky exposure.

In your scenario, you completed a 17-day course of PEP. If the second exposure has been confirmed as HIV-negative, then you may not need further HIV tests. However, if there is any doubt, it may be advisable to undergo an HIV antibody test after 90 days from the exposure.

I hope this information helps you.

Feel free to ask further queries.

Thank you.

Patient's Query

Hello doctor,

Thank you for the reply.

I tested negative on days 22, 27, and 35 after my first exposure. Immediately after the negative 35-day fourth-generation lab test, I started PEP for the second exposure. After the first exposure and negative tests, I experienced some initial symptoms. I continued with PEP for 17 days and discontinued it as my partner tested negative and was confirmed negative via lab testing. During PEP, I still experienced unexplainable symptoms, which were bothersome. However, after discontinuing PEP, I began feeling terrible about a week later and still do not feel like myself.

Kindly help.

Answered by Dr. Basti Bharatesh Devendra

Hello,

Welcome back to icliniq.com.

If the 4th generation test taken 35 days after the first exposure yielded a negative result, the likelihood of subsequent HIV tests returning positive due to the initial exposure is very low. Moreover, if it is negative at 112 days post the first exposure, it is considered conclusive. The symptoms experienced may not be related to HIV. I advise consulting your doctor for examination and management of any symptoms you may be experiencing now. If there have been no further exposures, additional HIV tests may not be necessary.

Thank you.

Patient's Query

Hello doctor,

Thank you for the reply.

Could the 17 doses of PEP between the first exposure cause delayed seroconversion for HIV-1 or HIV-2 antibodies? My last test was conducted 112 days after the first exposure, and I have not had any further exposure since then. I am concerned about symptoms experienced before, during, and after PEP. Could we discuss my symptoms further?

Kindly help.

Answered by Dr. Basti Bharatesh Devendra

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

As per protocol, even with PEP intake, the three-month period is sufficient for seroconversion. The symptoms may not be related to HIV, especially considering that the HIV tests have returned negative results.

I hope this information helps you.

Feel free to ask further queries.

Thank you.

Patient's Query

Hello Doctor,

Thank you for the reply.

Is there sufficient time for seroconversion for HIV-1 & 2 antibodies even with 17 doses of PEP? Would PEP not suppress viral load or antibody response? In my area, HIV-2 is not very common according to medical practitioners, but it is still possible. Would a 4th-generation test at 112 days, regardless of the 17 days of PEP, still detect antibodies for both HIV-2 and HIV-1?

Kindly guide.

Answered by Dr. Basti Bharatesh Devendra

Hello,

Welcome back to icliniq.com.

Yes, it would detect both HIV-1 and HIV-2 antibodies.

Thank you.

Patient's Query

Hello doctor,

Thank you for the reply.

So I should calm down about all these unusual symptoms and not feeling well. I felt at my worst after PEP.

Could it not be related to HIV at all? There are so many symptoms, though.

Kindly help.

Answered by Dr. Basti Bharatesh Devendra

Hello,

Welcome back to icliniq.com.

It is unlikely to be related to HIV. Please consult your doctor or physician for examination and management of your symptoms.

Thank you.

Patient's Query

Hello doctor,

Thank you for the reply.

I have been struggling with appetite loss and experiencing some other symptoms since I discontinued the 17 doses of PEP. Additionally, I had some strange symptoms both before and after PEP following the first exposure.

I believe that by now, if the symptoms were related to HIV, something would have appeared on the tests for HIV-1 or 2 antibodies.

Kindly help.

Answered by Dr. Basti Bharatesh Devendra

Hello,

Welcome back to icliniq.com.

The symptoms are nonspecific and may not necessarily be due to HIV. Please follow up with your doctor if they persist.

Thank you.

Patient's Query

Hello doctor,

Thank you for the reply.

The symptoms are quite concerning, but as you said, the HIV tests are negative, so they could be due to something else.

Kindly help.

Answered by Dr. Basti Bharatesh Devendra

Hello,

Welcome back to icliniq.com.

Wish you safe and good health.

Thank you.

Patient's Query

Hello doctor,

Thank you for the reply.

Just one last question: Will a late PEP during the acute phase have no effect on the development of HIV-1 or 2 antibodies if truly exposed during the first exposure?

Kindly help.

Answered by Dr. Basti Bharatesh Devendra

Hello,

Welcome back to icliniq.com.

In your scenario, it will have no effect.

Thank you.

Patient's Query

Hello doctor,

Thank you for the reply.

So I can relax regarding the possibility of HIV-1 or 2 antibodies and late seroconversion due to the 17 doses of PEP. I would still produce antibodies for both regardless of the 17 doses of PEP.

Kindly guide.