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PEP and Positive Elisa Results, Negative WB and RNA
Apr 28, 2014

Hello, first off I would like to explain my recent events that led me to the Pep treatment. This is all happening while I am living in Italy so speaking with the doctors is a little unclear.

On March 3 I had unprotected reciprical oral sex (with no encounter to sperm) with someone who was recently infected with HIV (They received their positive results on March 13).

On March 12 I had another encounter with him, however, this time there was slight receptive unprotected anal penetration (he never went fully inside me) he ejaculated on my facial area and a little of it went in my mouth. I had a slight blister in my mouth and tears in my anal area earlier in the day.

On March 13 he received his HIV positive results (he was in an acute stage as his test one month prior turned back negative). He told me about his results and I went to the hospital and started the PEP 30 hours after the exposure (Truvada and Isentress).

My initial HIV 4th gen test came back negativie (taken on March 13) so I know that I was negative before this encounter.

I had blood taken at the 2 week post exposure mark, and then again at the 3 week post exposure mark (while on PEP, and I am still on PEP, around 40 days post exposure)

The docotor said that my body came in contact with the virus, however, the second test (3 week post exposure) reacted a lot less than the first test (2 week post exposure). She further said she believes that I was exposed to the virus, however, I probably took the PEP in time to abort it. She suggested I do a DNA test as the ELISA and RNA test would not be valid while on PEP. She further said I will not get my true results until I stop taking the PEP.

Being unable to go back to the docotor for further tests (At this point I moved from Rome, where the event took place, to Bologna for work) I found a clinic in my area and went there for further testing on April l3 (apx one month post exposure).

The docotor confirmed that my body came in contact with the virus. He said the 4th Gen test was slightly reactive and came back at 1.3. He also said that the western blot and RNA test came back absolutely negative. He said, even on PEP, he should be able to find some copies of the virus, which he was unable to do. He said he beleives that it's highly possible that I came in contact with the virus, however, started the PEP in time. He wants me to get another test to see if the HIV DNA integrated into my cells.

Here are my questions

1) What is going on?? 2) If I came in contact with the virus, can I produce antibodies, even if the PEP was successful? Would that explain the positive results on the ELISA and negative results for western blot and RNA? 3) Can you produce antibodies even if the virus has not integrated fully into your system? 4) Do I really have to suspend the PEP in order to get my true results? 5) Does the 1.3 result mean that I have a high probability that I am positive? I feel like he is just trying to make me go back to the office so he can tell me that I am positive in person. 6 and last) What are the results like on HIV tests on a person that was exposed, however, went through a successful PEP and aborted the virus?

Response from Dr. Wohl

I am not sure exactly what your situation is. Having the actual results of each test so the the of test and the result are clear, would help.

It MAY be that you had some reactivity to an HIV antibody test. That could indicate evolving immune system reaction to HIV, as would occur during early infection, or false positivity.

A RNA PCR is valid when PEP fails as the virus replicates. However, if PEP is delayed and a person becomes truly infected then starts PEP, the meds act as a treatment and the viral load can respond and become undetectable.

The DNA test will determine if HIV has integrated into your cells. It is worth doing.

I agree with stopping the HIV medication if it remains unclear whether you are infected or not. A short break in therapy will allow for detection of the virus, if present.

All this should be done under the direction of an HIV expert.

DW



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