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boyfriend tested +
Mar 7, 2004

Hi Dr. Bob, my boyfriend tested positive in January (December was negative). Since there was unsafe encounter between us shortly before he found out the result I started PEP within 40 hours after. Before the medication blood samples were taken and the elisa, virus load and p24 test did not show any positive result. Four weeks of Kaletra and Combivir were over and I waited two more for the next blood test. Is this the right time frame to be tested again? After what time is it possible that the virus load or the p24 test show a result that can lead to an hiv infection? In case on this test I show positive on the virus load or the p-24 but negative for antibodies would it make sense to start medication right away to stop the virus spreding further and changing into an akute hiv infection? Thank you.

Response from Dr. Frascino

Hello,

Sorry to hear about your boyfriend's recent positive test. He was negative in December and positive in January? Why was he testing on a monthly basis? Did he have his positive test confirmed to be sure it wasn't a false positive?

OK, let's assume he is indeed positive, and you had an "unsafe encounter," started PEP within 40 hours, and took the full four weeks of Kaletra and Combivir. First off I'd have some questions about that. For instance, how much risk was there with the "encounter" (receptive/insertive, etc.), how high was his viral load, why were you given both Kaletra and Combivir for PEP, did resistance testing on your boyfriend's virus indicate you needed this potent of a regimen with its inherent risk of doing toxicity, etc., etc., etc.? But, let's put all that aside and just take the scenario you describe. The current recommendations state that persons with non-occupational HIV exposures should receive medical evaluations, including HIV antibody tests at baseline, 4-6 weeks, 12 weeks, and 6 months.

I would not worry about the "what if's" (what if the viral load is positive but the antibody still negative, etc.), as they are hypothetical and the options and decisions regarding therapy are complex. If you do test positive, see an HIV/AIDS specialist. He/she will review all the various options with you in detail.

Good luck.

Dr. Bob



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