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(revised email)PEP treatment for only a week and the window period
Apr 18, 2014

Hi there. I need some medical expert's help. Hope you understand some defective sentences because I'm not used to use English as a poreigner. I have several questions about pep. I had unprotected anal sex with no ejaculation in my rectum with a person who might be hiv positive.

8 days hiv exposure, I took a PEP with two antiretroviral drugs for ONLY A week although PEP has little effective or at all within more than 72 hours, which is I know later, becasue so frecked out that time.

Here some symtoms appeard on me. 3 days hiv exposure, I had a rash on my back and experienced slight fever. It never had happened that before for me. 3 weeks post-exposure, my lymph nodes on my neck had been swollen for 4 day. 8 weeks post exposure, feeling some fatigue, my lymph nodes has been enlarged for about 5 weeks even now.

However, fortunately, all the test result that I took has been negative: 3 weeks post-exposure, a week PEP finised ; 4th generation ag/ab test Negative 8 weeks post exposure, 6 weeks PEP finished ; 4th generation ag/ab test Negative (0.16) 9 weeks post-exposure, 7 weeks PEP finised ; rapid kit ab test Negative 12 weeks post-exposure, 10 weeks PEP finised ; 4th generation ag/ab test Negative

I heard in wiki following contents : Antiretroviral therapy during window period can delay the formation of antibodies and extend the window period beyond 12months. This was not the case with patients that underwent treatment with post exposure prophylaxis. Those patients must take ELISA tests at various intervals after the usual 28 course of treatment, sometimes extending outside of the conservative window period of 6 months.

And I heared somewhere a domestic case that a person who took PEP had occured seroconversion Negative to Positive 11 months post exposure although ag/ab tests for 10months had been Negative.

1. All these circumstances into consideration, will I infected?

2. Dose PEP treatment for only a week at 8 days post exposure interfere with my test result? And how long extend the window period.

3. When is the appropriate time should I get tested to get confimed conclusive result?

4. Rash on my back apeared at 3 days post exposure ,so called acute retroviral syndrome, has someting to do with HIV infection?

5. Dose swollen lymph nodes lasting ,even now, for 5 weeks after 8 weeks post exosure have relations with HIV infection? Or another undefined virus infeection? so anxious.

6 If cause of my swollen lymph nodes was HIV, could it be detectable with ag/ab test that I took at 12 months post exposure?

thank you for reading this, I am really approciate your help, believing you make my concerns solved! Thanks again.

Response from Dr. Wohl

You raise several important questions.

Foremost, your rash could (and I think most likely) represents not acute retroviral syndrome but a possible other STD like syphilis. I won drake sure that you were tested for that infection as it can cause rash, swollen lymph nodes and fever and then disappear.

Your testing has been rigorous and shows you are not infected with HIV. You took only a week of PEP. Assuming it was ineffective, you would become infected. That means virus in your body. That in turn means virus that causes antibodies to be produced AND virus that can be measured in the blood.

When PEP fails and infection ensues virus is by definition present. Older studies using older techniques have described longer than typical antibody production in rare case of PEP. Many more studies and reports show the more typical pattern of p24 or PCR detection of virus early with PEP failure.

I recommend you repeat testing with combo test at week 24 and when negative convince yourself that you are really done with HIV testing.

DW



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