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I need an immunologist to answer this. PLEEEASE!
Jun 13, 2011

Dear Dr. Bob, Please answer my question! Im desperate! I was mistakenly given pep 6 weeks after a possible exposure. 1.What are the chances that my body had antibodies already by the time I started PEP? 2.And if antibodies were already present, would they remain in my body throughout the course of PEP (28 days) or disappear? I am asking this because I tested negative after 9 weeks from exposure (still on PEP), but have concerns if PEP has delayed my seroconversion. I had all ARS symptoms after 4 weeks. As you can see, I am not that typical patient that receives PEP within 72 hours from exposure. If infected, I was exposed to the virus for 6 weeks. Do you think Id show up positive in my 9 week test? This is my only hope now that I am not infected. I did 2 tests: a rapid check and a DUO test. Also, I have NO idea when a person in my case should get tested. The CDC guidelines recommend HIV follow-up testing at 4-6 weeks, 3 months and 6 months. In my particular case, should I do this from exposure or from taking PEP since my case is completely off the guidelines to start with? Nobody knows how to answer this. I believe you can answer this or refer me to an immunologist who studies this topic, if possible. I trust you! Id appreciate your input, even if it is just theoretical as you might not know of many cases like mine. Thanks a lot!

Response from Dr. Frascino

Hello.

I'm glad to help out. But first I have a question for you. How were you given PEP mistakenly and why are you still taking it??? PEP is definitely not warranted or advisable six weeks after an exposure.

Responding to your specific concerns:

1. The vast majority, but not all, HIVers will have detectable levels of specific anti-HIV antibodies in their blood within four to six weeks following primary HIV infection.

2. PEP would not cause anti-HIV antibodies to decrease or disappear. If you had anti-HIV antibodies, it would mean you are HIV infected. PEP is comprised of the same antiretroviral medicines we use to treat HIV disease. These antiretrovirals can drive HIV viral load (different from anti-HIV antibodies) to undetectable levels; however, the HIVer remains HIV positive (that means HIV-antibody positive). By way of example, I've been on antiretrovirals for years. Currently my viral load is undetectable, but I would still test HIV positive on HIV-antibody testing (still have anti-HIV antibodies in my blood).

3. Regarding HIV testing, I recommend you stop PEP immediately and take HIV tests at three months (and six months if the exposure was significant) from the date of exposure.

Good luck.

Dr. Bob



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