RE: Scared. HIV - (so far)...
Aug 21, 2008
Dr. Bob, First, thank you so much for the prompt response to my earlier post. I really appreciate it.
The issues you raise regarding my physician aside for the moment, I wanted to focus on the gist of the original question, which was not answered (and I haven't been able to find answers elsewhere on this). Does a course of HAART affect the window period for seroconversion?
You told me that my 4 month test was definitive and - God knows - I would like nothing more than to believe that - but a) I still have symptoms I can't explain and b) have read that some people don't seroconvert until 6 months or more. Any additional data you can provide on HIV test accuracy for individuals who (rightly or wrongly) underwent PEP would be greatly appreciated.
Thanks in advance, - Joe M.
Response from Dr. Frascino
Hello Joe M.,
The guidelines are very clear. If you had a significant risk that required PEP (which you didn't), and you took PEP for a full course of 28 days (which you exceeded in a very dramatic way), the follow-up post-PEP HIV screening should be done at three and six months from the date of exposure. Delayed seroconversion is not a consideration if one follows the guidelines.
In your situation, oral sex with a partner of unknown HIV status, a test at three months is all that's required. Your inappropriate use of antiretroviral medications would not affect your HIV-antibody test result. OK?
Scared. HIV- (so far) but with symptoms Aug 19, 2008
Hello Dr. Bob, In a visit overseas in March of this year, I ended up drinking (way) too much at a bar and having oral sex (both receptive and insertive) with a sex worker. The next morning, I was mentally and emotionally devastated. (I am happily married with two children - could not believe what happened). Compounding it, I felt nausea, headache, chills, sweats, pain in my esophagus, and could barely get out of bed. I felt this way for approximately 72 hours, including the plane trip back to the States. 4 days after the event, I visited my doctor, told him the whole sordid story, and broke down essentially, fearing the worst from the symptoms I was having. While he said the chance of contracting HIV from either type of oral sex was low, he put me on Atripla for 12 weeks. I have been tested 3 times now, my most recent test on July 24, about 4 months after the incident. All have been negative. However, I do not feel well - I have had 4 or 5 incidents of night sweats, I have palpable, often painful lymph nodes in my armpits, and periodic neurologic symptoms (feel dizzy, light headed). My question to you is how reliable is the hiv test at 4 months? Does the regimen of Atripla I received change the normal window period? Thanks in advance for your response - and God bless you for the work you are doing. - Joe M.
Response from Dr. Frascino
Hello Joe M.,
Your doctor didn't do you any favors. First of all, PEP is not warranted for such a minimal risk (oral sex with a sex worker of unknown HIV serostatus). Next, if PEP was warranted (which it wasn't), it would need to be started as soon as possible and no later than 72 hours after the exposure. You didn't visit your physician until well after the 72-hour cutoff point. In addition, if PEP was warranted (which it wasn't) and you were within the 72-hour timeframe (which you weren't), a full course of PEP is 28 days, not 12 weeks! I have no idea what your doctor was thinking, but he clearly is woefully uninformed about HIV post-exposure prophylaxis!!
1. Stop your Atripla immediately. It was never warranted and even if it was (which it wasn't), you've had way, way, way more of it than is recommended for a full course of PEP.
2. Level with your wife, if you have not already done so. It's the best way to confront your guilt and it's the right thing to do.
3. Your repeated negative HIV tests out to four months are definitive and conclusive. HIV is not your problem. No way. No how. Yell WOO-HOO!
4. Find a more competent physician!!! The one you currently have is in drastic need of a basic remedial course on HIV/AIDS. Perhaps you should download a copy of the current guidelines for nPEP (nonoccupational post-exposure prophylaxis) and give it to your doctor in the hope that he won't make the same mistakes with other patients. The guidelines can be downloaded at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm.
Your unfortunate story is an excellent example of why I repeatedly advise all folks who have had an exposure significant enough to warrant PEP be followed by an HIV specialist. Any HIV specialist worth his salt would never have prescribed PEP for you. And if you had been referred after starting PEP, the specialist would have immediately stopped it. You can read more about PEP in the archives of this forum.
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