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Q. I took PEP after possible exposure. Will this alter my HIV test taken after five months?

Answered by
Dr. Ravinder Kaur Sachdeva
and medically reviewed by Dr. Sushrutha Muralidharan
This is a premium question & answer published on Sep 06, 2021

Hi doctor,

I had intercourse six months ago without a condom (but after six months of intercourse, she checked HIV antigen and antibody, p24 - negative), but she was positive for HSV 2. Again five months ago had intercourse with a condom (but oral sex without a condom). Then the very first day started PEP but took 24 days only. The other four were aborted due to side effects. However, the next month second week, I had back pain associate with driving and had moderate pain while driving. Then, the next month first week started burning feeling while urination, burning of feet, and painful defecation with frequent defecation. I then checked HIV (antigen and antibody, ELFA method), HSV 1 and 2, VDRL, TPPA, chlamydia, and gonorrhea PCR. All Negative except HSV 1 (It is positive for 15 years). The STD doctor gave Acyclovir 10 day course, but I took it for 15 days. While on Acyclovir, around three months back, I had a penile lesion but settled within seven days. However, others stayed the same.

Then, I started having lightheadedness (I had most days and more hours during the day), after that doctor started treatment for prostatitis. I took it for two weeks but no improvement. Then started skin itching (commonplace is upper back but no visible rash) sometimes had formication. Skin itching started the very next day of the Covishield vaccine. Then after four months of exposure (the second girl, because I think the first girl cleared HIV, she did HIV test this month and it is negative), I did HIV antigen and antibody CIMA test and HIV antigen and antibody p24 all negative. And HIV RNA was negative. Also, after five and half months, HIV antigen and antibody p24 done two times with two reputed laboratories showed negative. Now I have mild burning of urination and mild burning of feet, headache on and off, back pain (while driving), neck pain on and off, mild burning feeling of the back, mild itching all over the body, and upper back itching (but no rashes). Does PEP delay the window period this much? If so, how it increases the window period? Should I test more, or my tests already showed conclusively? Should I worry about non-gonococcal urethritis and sexually acquired reactive arthritis? Even though I had negative chlamydia and gonorrhea PCR tests. Does PEP affect all those fourth-generation test results? Please give your opinion.

#

Hi,

Welcome to icliniq.com.

I am first going to mention the best part of the complete description given by you:

1) Both the partners, with whom you had exposure, were tested HIV (human immunodeficiency virus) negative.

2) You had started postexposure prophylaxis and completed it for 24 days. Although four days short as per mentioned guidelines, it will be considered adequate in your scenario.

3) Your HIV tests are also negative after about five months of last unprotected exposure.

So, to answer your question, I am just mentioning the below facts:

1) The recommendations are to get tested at four to six weeks of last unprotected exposure by a rapid fourth-generation HIV combo test. If the result is negative, get a confirmatory rapid HIV antibody test at three months of last exposure. If the test is negative at three months and there is no further exposure, there is no need to repeat the test. This stands true in your case as well, even if you had taken PEP (postexposure prophylaxis).

2) Besides this, if your source at both times was HIV negative, and if you had no other exposure, HIV infection cannot be acquired. However, it can be acquired if there is an unprotected exposure with HIV infected person. Also, there are numerous factors that determine the risk of acquisition, which can not be applied in the scenario where the source was negative.

3) Regarding the penile lesion or prostatitis history which you mentioned reflects other STI (sexually transmitted infection) which share the same route of acquisition (unprotected sexual contact anal, vaginal or oral).

Non-gonococcal urethritis is curable with a short course of antibiotics. You can share your earlier prescription and medication taken for it so that I can advise accordingly. The other symptoms which are mentioned could have various reasons and do not mean HIV. You can share your reports through this platform if you feel comfortable.

I suggest you the following tests:

1) Complete blood count, LFT (liver function test), serum creatinine.

2) HBsAg (hepatitis B surface antigen).

3) Anti-HCV (antibody hepatitis C virus).

4) VDRL (venereal disease research laboratory test)

5) Herpes simplex 1 and 2 IgM (immunoglobulin M) and IgG (immunoglobulin G).

6) Serum Vitamin B12 and D3 levels.

7) Thyroid profile.

As far as HIV is concerned, you can consider your test result conclusive if there is no further exposure. Above mentioned tests will help to identify other STIs or any other chronic ailment. I hope this was helpful.


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