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PEP again!
Apr 15, 2011

Hello Dr Bob, firstly I hope you are ok? You have been absent a while, I hope it's a well earnt holiday. I know you do an amazing job whilst having to deal with HIV daily - so I'm hoping your absence is down to a break and hope you haven't been ill.

If it's a holiday that you've been on, would you be kind enough to continue answering my questions (i've asked a few since you last answered me so you're probably totally sick of me posting to you) I wont go over my exposure again

2 weeks after stopping PEP I developed a weird illness - light headedness, dizziness, "unreal" sensations, this passed after a few days and I tested negative using a fast test.

3 weeks after stopping PEP I developed very swollen lymph nodes in my neck, pain in groin - I got examined and they confirmed the swollen lymph nodes in neck, none found anywhere else, and did a 4th generation lab test which came out negative, they got me in 7 days later to repeat the test and again, it was negative (this was 4 and a half weeks after stopping PEP, 8 and a half weeks after the incident).

Yesterday I noticed a few red marks on my neck, possible ARS rash?- and my neck lymph nodes are still enlarged (3 weeks of enlarged lymph nodes, this is nearly 5 and a half weeks after stopping PEP)

1. Do you have confidence in 4th gen duo tests 28 days after an incident as other sites in the UK are? Would you be confident with PEP involved, my test was 30 days after PEP.

2. If my enlarged lymph nodes was due to HIV, would you have expected one of the tests to show positive?

3. I haven't had a fever - is this a good sign? The red spots on my neck, that may or may not be ARS rash, if it is, and I test again, would it finally show up on the duo test?

I know I need to test at the 3 month mark post PEP to be fully certain, I know the lymph nodes can't be a coincidence. thanks for answering my questions.

Response from Dr. Frascino

Hi,

I was in London, Milan, Lake Como and Bellagio: and yes it was mostly vacation. We had a wonderfully restful and restorative time. However, it sounds like you continue to be a worried wreck!

Regarding your symptoms, the rash is not consistent with ARS. Similarly, isolated enlarged neck glands are not consistent with ARS, which would generally present with generalized lymphadenopathy (multiple sites).

As for your repeatedly negative post-PEP HIV-antibody tests out to 8.5 weeks from the incident, this is extremely encouraging. The published guidelines recommend post-PEP HIV-antibody testing at four to six weeks, three months and six months from the date of exposure for a conclusive negative result.

Responding to your specific questions:

1. See above.

2. Yes.

3. Fever is present in approximately 96% of cases of ARS. The red spots are not consistent with ARS rash.

Stop worrying the odds are now astronomically in your favor that you did not contract HIV.

Good luck.

Dr. Bob



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