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Begun PEP, now what?

Jun 18, 2009

I had a drunken night that included something possibly being slipped into my drink, because the rest is a blur. I was at a gay resort and made the mistake of venturing out after my friends already went to bed. In any event, I remember having receptive anal sex but do not recall if a condom was used. I estimate this occurred around 2 a.m. that day. Later that evening I went to ER and asked about PEP. Was told I would need to visit primary doctor. I am a student and do not have a primary doctor, but I found one the next day and started PEP about 6 p.m.

I am admittedly a hypochondriac when it comes to these types of issues, and I wondered can overwhelming anxiety about HIV cause real physical symptoms? The highest my temperature has been is 99.3. I don't think I have any swollen glands, as I'm sure I'd be able to clearly know if I did. I saw a white dot in the back of my throat but now it's gone. There are a couple red dots on the roof of my mouth now. My stools are loose (but that could be PEP-related?), and they were slightly before PEP too (but that could be from the alcohol/possible drug in drink/or maybe just stress?). My appetite has been almost nonexistent but when I eat I'm able to eat pretty much normally.

I'm an extreme worrier, if you can't already tell. I find myself constantly checking for any new mark that I'd have to research online to confirm if it's related to any of this or not or what might be causing it, almost to the point I feel I'm driving myself crazy!

So questions for you: -If acute HIV symptoms were to show up, would they ever show up the same day as infection? Or on average, how long does it take before they would show if they were to? -The doctor ordered an antibody test already, which came back negative, but of course I am well aware of the window period. I know from your forums you are against PCR RNA tests for diagnostic purposes because of rates of false positives. But I read on the CDC Web site such tests could detect HIV as early as 9 to 11 days. I am in Day 3 of PEP, and I HATE THE PEP SIDE EFFECTS! Could I continue PEP for 11 days and get a PCR RNA test to confirm if continuation of PEP for 28 days is necessary? I will of course follow up PEP with the 3-month and 6-month antibody tests, but I wanted to know too how much time should pass after PEP before a PCR test might be taken for accuracy?

Thank you for everything you do!!

Response from Dr. Frascino


Can overwhelming anxiety about HIV cause real physical symptoms? Absofrickinlutely! Just take a read through the archives of this forum and you'll find ample evidence of this fact (psychosomatic illness).

To address your specific questions:

1. No. Symptoms associated with HIV acute retroviral syndrome (ARS) take several weeks to become manifest following primary HIV infection.

2. No. PCR RNA testing (viral load testing) makes absolutely no sense while you are on PEP. PEP (post-exposure prophylaxis) is comprised of antiretroviral medications. If you were HIV infected, these antiretroviral medications could theoretically drive an HIV plasma viral load to undetectable levels. You would then test HIV PCR RNA undetectable, even though you could be HIV infected. That is why PCR RNA cannot be used as a diagnostic test in this type of situation. My advice is to follow the PEP guidelines. You can read more about these in the archives of this forum.

Good luck.

Dr. Bob

Commenting on comments
Horrible mistake

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