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PEP and Testing
Aug 31, 1999

I've read a couple of questions on this and I would be interested in getting your clarification, since I had a potential exposure (a single instance unprotected sex with a prostitute). When I woke up and realised what I'd done, I basically forced my doctor to give me PEP. Now I'm concerned that this will prejudice my testing results and so I won't be able to put my mind at rest for months if not years even if I get negative results. So, here are the questions:

1. If I was infected, I presume the PEP could drive the viral load level down, perhaps to undetectible levels. However, once the PEP stopped wouldn't you expect there be 'rebound' or at least the normal prgression of viral load from that point onwards? Therefore, a PCR test some 10 weeks after the cessation of PEP (i.e. 14 weeks from exposure) combined with a negative ELISA at the same time should leave me pretty reassured, shouldn't it?

2. If the answer to question 1 is "yes", I guess from your previous answers that this is still a slightly qualified "yes"! In other words there is a small chance I could not have a detectiable viral load and still not have developed antibodies. If you put yourself in my shoes (I realise that you're not that stupid, of course), what further tests would you take and when before you would say to yourself "OK, that's enough."?

I know this is not really a question for this forum, but you have been so helpful to others in a similar situation that I hope you will be able to find time to answer my questions. Obviously, I'm worried about myself, but I also do not want to put anybody at the slightest risk by resuming a (safe) sex life earlier than I should.

Response from Dr. Holodniy

We don't have enough data to answer these questions. There have not been enough people infected following high risk exposure and then receiving PEP to understand the kinetics of antibody and viral load development. MH



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