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PEP and RNA PCA detection
Jan 12, 2011

I believe I was exposed to HIV several days ago and, after discussing the details with several medical health professionals, began pep. I have begun a post exposure prophylaxis regiment of combivir and kaletra (begun 30 hours after potential exposure). I am wondering: if I have a PCR RNA viral load test done 1 week after exposure, what can I expect from the reliability of the results? If I get a negative is it actually the cases that I very likely did not contract the virus or might the retrovirals I am currently on just suppress the viral load to an undetectable level? It's my understanding the viral load associated with the primary infection is quite high. Do the retrovirals I am currently on have the ability to mask an active infection in my system?

Would it make an once of medical sense to stop my medications some period of time(1 day/ 12 hours) before the test so a true positive could be detected only to immediately resume medications while waiting for the results? Or, would this totally negate the potential benefits of PEP?

Response from Dr. Frascino

Hi,

The purpose of PEP is to abort or prevent HIV transmission. The medications used are the same antiretrovirals in the same dosages used to treat active HIV infection. PCR RNA testing should definitely not be done while on PEP. PEP could indeed suppress the plasma viral load to undetectable levels, which would result in a "false negative" result if the PCR RNA was being used for diagnostic purposes.

Stopping PEP to take a diagnostic test would be an extremely bad idea. Nonadherence to the PEP regimen could decrease its effectiveness.

I suggest you follow the PEP guidelines, including recommendations for post-PEP HIV-antibody testing at four to six weeks, three months and six months. You can read much more about PEP in the archives of this forum. Have a look!

Dr. Bob



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