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useful tests? ARS after PEP possible?
Aug 15, 2010

Dear Dr. Frascino, i just wanted to inform you that my 5week post exposure test (Elisa and DUO) came out both negative. During PEP I experienced fatigue and dry cough and a bit of chest pain in the last two weeks of PEP. At day 13 postexp i had a blood test and chest x ray which were both normal. Unproductive cough (which turned into productive with yellow mucus) is now fading slowly. From day 10 till day 28 I my fever was in the range from 36,8 to 37,2. After PEP it dropped to normal 36,6. Three days after PEP i got a strong fatigue feeling which persists till today (7 week postexposure), I also experienced a slight headache, higher and strong heartbeat during this period. I am really struggling to be productive at work. I experienced no high fever, sore throat (only cough), enlarged lymph nodes nor rash. My speacialist said that considering the low exposure risk, he would not even advice testing at 6 monts after exposure. I know it's against CDC guidelines though the UK guidelines say 3 months post PEP should suffice. I really do not know what to do anymore. I can't keep on working with this fatigue and slight nausea (it can't be due to PEP side effects). It cannot be becaouse of stress, i think i m really relaxed. 1. Can Ars take so long (fatigue persisting since week 1 post exposure)? 2. Would the tests done 5 days after beginning of the second fatigue and headache wave (ARS) grab the antigen or antibodies? Is it too early for the test to pick up the virus, 5 days after ARS? My specialist claims I shoulg not worry about it... Need advice. Thank you. D.

Follow up (Submitted Aug 14, 2010)

Dear Dr. Bob,

I forgot to mention that for PEP I took a three drug combination (with a PI) after the insertive oral sex incident with cut. My specialist mentioned that he might not warrant it. I received PEP from an emergency doctor in Cape town to minimize any potential risk. My specialist also mentioned that in his view I am not infected regarding the risk, PEP and incidence. But I do not know why these symptoms. He says it should be something else. I trust your opinion somehow more.

Thank you very much again.

D.

Response from Dr. Frascino

Hello D,

1. No.

2. Test reliability/validity is baed on the time from infection/exposure, not ARS. Current post-PEP testing guidelines recommend an HIV-antibody test at four to six weeks, three months and six months from the date of exposure.

I agree with your specialist: PEP was not warranted and your chances of having contracted HIV are nearly nonexistent.

Whatever is causing your fatigue, I strongly doubt it's HIV. Anxiety and/or depression could be the cause. You may "think" you're "really relaxed"; however, the tone of your multiple posts would indicate you are anything but. If no physical cause can be found for your fatigue and nausea, an evaluation for psychosomatic illness would be warranted.

Good luck.

Dr. Bob

Please please help! Mistake of my life!!! Jul 20, 2010

Dear Dr. Bob,

I know unprotected oral sex bears a relatively low hiv risk. However, during unprotected oral sex with a part time sworker i experienced a cut(1mm radius) on the glans of my penis. Later i had protected vaginal sex with no contact with any bodfy fluid. Hence not knowing the likelihood of the girl having potential bleeding gums (almost sure she was positive . black southafrican part time sex worker in cape town, who i met in a nice lounge) I was prescribed PEP 9 hours later. I am day 21 after exposure. What are my odds of getting infected. When should i get my first test after pep ? My specialist has said i should do it right after the finishing PEP... Thanks a lot for your help! I will donate as soon as i get home!

Response from Dr. Frascino

Hello,

Your HIV-acquisition risk is exceedingly low, even considering your 1 mm scratch on Mr. Happy's head. You are correct: Oral sex carries only a very low risk for HIV transmission. That you took PEP nine hours after the incident further lowers your already very low risk of acquiring the virus.

Guidelines for post-PEP HIV testing recommend follow-up HIV-antibody tests at four to six weeks, three months and six months from the date of exposure.

Thank you for your support of The Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's urgently needed and warmly appreciated. In return I'm sending you my good-luck karma that your post-PEP HIV tests remain negative.

Good luck.

Dr. Bob



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