Does PEP eliminate HIV risk after exposure?

Question

Hello doctor,

I had protected vaginal intercourse with an HIV positive woman, and I had taken PEP after 42 hours of exposure. I was tested negative at the baseline with a PCR (Polymerase Chain Reaction) RNA (Ribonucleic acid) test, and after completing PEP (Post-exposure Prophylaxis), my blood was drawn again for a PCR RNA test, and it took five days to get the results. I am very happy that the result came out to be negative. The day after drawing my blood for a lab test, I experienced persistent pain in the neck for almost two weeks (the area around lymph nodes for two weeks), and I immediately went to the doctor, who examined my body and neck to see if there were any swollen lymph nodes. He concluded that there are swollen lymph nodes, and I am wondering about the reason behind this pain. It has been exactly 60 days after the exposure and 30 days after completing PEP. Have you seen anyone who had protected intercourse and completed PEP and later seroconverted? Does PEP delay seroconversion? If not, why does it recommend testing up to three months after exposure? Have you ever come across a PEP failure? I would like to do another test for peace of mind. Do you advise me to do it now, or do you want me to wait for a few more weeks and take the test?

Answer 1

Hi,

Welcome to icliniq.com.

Yes. In my practice, I have couples who are serodiscordant and still remain negative even after unprotected sexual activity, and even if they would not use PEP (post-exposure prophylaxis). The reason is that sexual transmission has the least chance of acquiring HIV compared to injections, which stand at almost 90 %. Next, used PEP for both injection attack and sexual activity, and still no positive result after completion of the course. PEP works by stopping the multiplication of HIV in cells and its further release. PEP will not delay conversion. It is recommended to repeat testing at three and six months because of the window period for HIV. No PEP failures to date in my practice. You can have tests after the completion of the third and sixth months. The sixth month is arbitrary.

I hope this helps.

Please feel free to reach out in case of further queries.

Thank you.