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RE: Oral sex, Ejaculate in Mouth, PEP
Aug 24, 2011

Hi Dr Bob

Thank you for answering my previous question, much appreciated.

Currently I am still on PEP. I wanted to quit but due to two main reasons I have not done so:

1) I have not been able to contact my partner to confirm his status via a rapid test 2) My house doctor (not the doctor who prescribed the PEP, which was a Trauma doctor) advised that I complete the PEP course as it may cause resistance to the drug in future if I were to stop the course prematurely. I started on Combivir and Aluvia but my doctor advised against taking the Aluvia i.e. I am now on Combivir only.

For some reason I am still worried and my doctor advised that I take a quantitative PCR test to calm me. The worry stems from cold like symptoms I developed about three days ago (sore throat and stuffy nose, no other symptoms).

I have taken the PCR test (15 days after possible exposure) and I am currently waiting for the results (should be out tomorrow, 23 August). I took an ELISA test ten days after possible exposure which was negative.

After taking the PCR test I did some googling and found that the PCR test is known to give false positive results and that it is not usually used to identify new infections. Am I correct in this assessment?

Secondly, as I have read many different opinions on this matter, when would you advise I take the next test (ELISA 4th I would imagine) and when.

Kind regards,

Werner (South Africa)

Response from Dr. Frascino

Hello, Werner.

Unfortunately you are continuing to get inaccurate advice from your doctors!

1. Discontinuing a course of PEP that was never indicated would not "cause resistance to the drug in the future"?

2. Taking a quantitative HIV PCR RNA test while on PEP makes absolutely no sense whatsoever, unless you feel your PEP regimen is failing and you have developed symptoms consistent with acute retroviral syndrome while on PEP. PEP uses a combination of full-strength antiretrovirals, essentially the same regimens used to treat HIV disease. If you were HIV infected (PEP not working), these antiretrovirals could drive your HIV plasma viral load to undetectable levels. If the quantitative PCR was being used as an HIV-diagnostic test, this "undetectable" result would then be a false negative (due to effective treatment). You are also correct the PCR tests can have false-positive results and are not generally used for diagnostic purposes for that reason.

I would suggest you consult a more competent/ knowledgeable physician.

Should you decide to complete your 28-day course of PEP, the guidelines for post-PEP HIV testing recommend ELISA tests at four-to-six weeks, three months and six months from the date of exposure. You can read much more about PEP and post-PEP testing in the archives.

Good luck.

Dr. Bob

Oral sex, Ejaculate in Mouth, PEP Aug 13, 2011



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