Slightly Different PEP Window Period Question (Will Donate!) (PEP AND THE HIV SEROCONVERSION WINDOW PERIOD, 2011)
Jul 23, 2011
Dear Dr. Bob, kudos to you and the great service you provide. Being in the midst of a labyrinthine and hellish psychological trap, here's hoping you can shed some light on a question regarding PEP and window periods. The recommendation for testing due to PEP for a specific exposure is clear, but what about a future incident? For example, if one took PEP for a specific exposure, but had another potential exposure later on in the future but did not take PEP this time around, would the 6 month window period still apply in the second instance because they had taken PEP prior? Or, would the PEP by now be out of the body's system, with no long term effects on seroconversion, and therefore the 3-month window period would return and be in place? I hope you find this question relevant and worth answering. On an aside, I was impressed to learn that you are a performing classical pianist. Do you specialize in any composers or styles?
Response from Dr. Frascino
Concerns about PEP extending the HIV seroconversion window are blown way out of proportion. There is no sound scientific evidence that I am aware of that proves (or even suggests) that PEP actually increases the HIV seroconversion window! The reason published guidelines recommend post-PEP HIV-antibody testing out to six months is that by definition anyone prescribed a course of PEP had a "significant" HIV exposure. Whether or not a course of PEP is taken, the CDC testing guidelines recommend HIV-antibody testing out to six months for all "significant HIV exposures" (for example, occupational exposures, unprotected receptive anal sex with a partner confirmed to be HIV infected, etc.).
To answer your question, an HIV exposure anytime after a course of PEP should be treated just like any other HIV exposure. If the exposure was significant, test out to six months. If it was questionable or extremely low risk, then testing out to three months would suffice.
Finally yes, I was trained as a classical pianist. On the music rack of my Bechstein grand currently you'll find Gershwin's Rhapsody in Blue, Scriabin Etudes, Chopin Nocturnes and a few works by Liszt, Rachmaninoff, Villa Lobos and Shostakovich. Steve (Dr. Steve, the expert in The Body's Tratamientos forum) and I are scheduled to perform a benefit concert for The Robert James Frascino AIDS Foundation in September. YIKES! That's coming up very soon. I really should be spending more time on my piano keyboard instead of this MacBook Pro keyboard.
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