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PEP and PCR Testing - Any effect?
Jul 21, 1999

I had unprotected sex with a "promiscuous"woman appoximately 10 weeks ago. She has subsequently tested negative using ELISA. However, she could of course be within a 'window period'. I tested negative both by ELISA and PCR some three days later and commenced PEP (Combid & Viracept) for 4 weeks. I have had numerous ELISA negative tests since then and have had no acute symptoms of HIV infection (though numerous that could be put down to acute stress!). I had a very mild rash on my upper arms and hands for some time (and still feel a very slight burning sensation sometimes). The rash was not raised and not easily detectable visually but was most definately there in the sense that I could feel it. I also have had an ongoing mild throat condition for the last four weeks or so. This is very "on-and-off" and I suspect, again, may be due to stress. A recent CBC & Diff indicated I had a ormal WBC count but a heightened percentage of neutrophils (which, I understand would be consistant with any viral infection or indeed acute stress).

Based on the above, I hope you won't mind answering the following:

1. I am about to take the 3 months ELISA test. I understand that antibodies usually deveolp in 3 months and, by 6 months, I can be 99% confident that a negative ELISA test will indicate no HIV infection. Will the fact that I had PEP have any effect on the interpretation of these ELISA test results?

2. Will having a PCR test at the same time (i.e. 3 months) be of any use (i.e. can I draw the conclusion that a negative ELISA and a negative PCR test means I am less likely to have contacted HIV than if I just had the ELISA test)?

3. Does the rash or the throat condition I described above sound consistant with HIV infection?

4. Would acute HIV infection, before sereoconversion, produce a higher level of neutrophils in a WBC count?

Apologies for the length of this query and the number of questions, but your answers would be of great help to me.

I really look forward to reading your response.

Response from Dr. Holodniy

1. Effective PEP is new phenomenon. There is no good data to answer your question directly. In the PEP studies that are ongoing, negative is being equated with negative. 2.Probably not. 3.Unlikely, put possible by themselves. 4.Usually the opposite (low WBC). MH



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