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PEP & Window Period & PCR (Tesla, GMan?)
#97636 - 05/05/04 04:23 PM
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I am just about to finish with a 28 day PEP treatment due to a high risk exposure. Do you have any idea how PEP may affect the window period for an antibody screen? Am I already 4 weeks into the window? Or does my window period just begin now when I stop taking the drugs???
What about a PCR test? When might I take a PCR test that is definitive. I have a doc appointment next week right after the PEP is done, but I can't wait for the answers. I'm way too nervous and scared!
Thanks for your help.
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As far as a ELISA test, the window period begins after you finish taking the PEP. 13 weeks after your last took the PEP.
The same goes for a PCR. But you must remember the PEP can cause a false POZ on the PCR test. So ots best to stick with an ELISA.
What was your risk????
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Hi there!
What was your high risk exposure? PEP guidelines have been set up for people with high level of exposure to HIV through their occupation. The effectiveness of PEP following a sexual exposure is still under a great deal of study. PEP seems to be less effective when a great deal of time has elapsed since the exposure. PEP ulilized within hours of exposure followed by Rapid Testing needs to be monitored sometimes up to 6 months due to the types of exposure. Needle stick, nonintact skin, and mucous splashes all warrant PEP in a healthcare setting. There have been cases of late seroconversion following a needle stick and this may be up to a year. The whole point of PEP via AZT, Zidovudine, or Cocktail is to inhibit viral replication in the "Window Period" thus giving one's immune system an HIV concentration level the immune system can handle in order to destroy the virus. Keep in mind that this was put in place because our immune system is not 100% helpless against HIV. So it becomes critical to ask what type of exposure the person likely had. HIV transmission rate to a host becomes high if the source had an extremely high concentration of HIV and if the "Risk of Exposure" was high. Depending on the half-life of the drug used in PEP and DMPK, it may be best to completely finish your PEP treatment. ELISA taken 3 months following PEP will suffice. If you absolutely want to be sure, then I'd highly recommend RNA PCR 1 month following the completion of your PEP.
On another note, human civilization is not completely helpless against HIV. When most of Europe suffered through hell via the Bubonic Plague, there were survivors. It has been documented that these survivors passed down a certain gene to a lucky few. Most of these people are of European descent. Evolution probably had a lot to do with it. People nowadays who are homozygous for a Delta-32 CCR5 gene deletion are likely to be immune to HIV. Back in February of this year, a European biotech company was awarded the patent for this gene. The gene codes for a membrane spanning G-Protein coupled receptor for chemokines. This is a great target of research for companies like Pfizer, Evotec, and just about every Pharma company that is out there. Hopely this research will provide good news in the future for many who are dying of this disease.
Be safe,
Tesla
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hey i read a study about PEP where Nurses were exposed via needlesticks all of them were watched carefully and all seroconverted around 40 days after infection and they were all using pep.
if you are using pep i think its best for you to do what your doctor says
good luck to you
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Thanks for your response. My exposure was broken condom with blood present with known HIV+ partner. I commenced PEP at about 24 hours post-exposure and have not missed a dose. Doctor prescribed a strong regimen (includes a PI) due to higher risk.
I'm curious about the testing schedule. I did find a response that Dr. Bob gave that said PEP should not alter the traditional window period...that is start counting weeks from day of exposure. But Dr. Gallant at the Johns Hopkins website said that the window period starts after PEP is over. I don't know which to go with. I guess I'll ask my doctor next week.
Why do you suggest an RNA/PCR at one month post-PEP? Why not a DNA/PCR?
Finally, if the PEP is suppressing the virus to undetectable levels right now, would I be experiencing any of the classic ARS symptoms?
Thanks
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tesla
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Reged: 04/28/04
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Both DNA and RNA PCR's are fine. RNA is just my favorite because it is directly looking for the original viral genome itself. Remember, DNA was transcribed from the viral RNA. Go with either one. I wouldn't look at any symptoms at the moment. As far as my opinion is concerned, I'd go with the one from Johns Hopkins.
Cheers!
Tesla
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Okay this thread is from 2004 and the first response to the original post is wrong.
The window period after PEP for the RNA test is roughly 10 to 20 days. if an RNA test is taken in that time, it will be approaching 90% accuracy.
False positives? He failed to explain himself. The biggest risk for false positives, is if you take that test while you are still on postexposure prophylaxis. iThis is because some virus may still be present from the exposure, which can later be eradicated by the PEP. However PCR testing *AFTER* PEP is completed is just fine. You should wait the recommended 15 days however.
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So to recap, circa 2012:
After completing PEP medications you can take:
1) RNA pcr test ($500+) at 15 days. Some doctors give it at 10 days but be safe and stick with 15.
2) DNA pcr test ($200) at 28 days. Some doctors give it at 22 days but be safe and stick with 28.
3) p24 Antigen test ($ ??) at 22 days.
These three will give you a 90%+ assurance of your status early on. You do not need to wait 3 months and endure 28 days of medications and deal with the utter mind f*ck. Believe me. I have been there. The 28 days of hell is enough. Save up some money and get a Qualitative RNA test 15 days after the meds and get some peace of mind.
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4) Antibody test at 6 weeks after exposure. This is the first recommended antibody test by the CDC. I believe it has no real value other than to tell you that PEP did not completely fail. It means the meds at least "did something". It does not have any value in telling you if you are going to remain negative on future antibody tests however.
5) Antibody test at 3 months after exposure. This is 2 months after PEP. This test provides 99% reassurance of your status.
6) Antibody test 6 months after exposure. 5 months after PEP. This test is no longer required, but recommended. The chances of being positive on this test after negative on the others is nill to none. But it will take you from that 99% to 100%.
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Most "support experts" on these types of forums will tell you to avoid the PCR testing after PEP and just find a hobby until 3 months has passed to get the antibody test. I call that nonsense, and it reflects that they have no respect for the mental anguish people have to endure in situations like these. The facts dont reflect their information either.
You MUST GET THE ANTIBODY TEST AT 3 MONTHS TO BE 99.9999% sure. However you can get your 90% reassurance MUCH SOONER with an RNA or DNA pcr test.
Period.
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One other comment. The post above which states that nurses were put on postexposure prophylaxis, and they all sero-converted at 40 days anyways? Totally dead wrong. The one study that was done on healthcare workers with postexposure prophylaxis, 81% of them remained HIV negative.
There are at least four or five other studies done on anywhere from 50 to 700 people, testing postexposure prophylaxis, in sexual encounters. In nearly all of those studies, everyone remained HIV-negative, or a miniscule number of people sero-converted.
For example, in one study with 700 people involved, seven sero-converted. And among those 7, one was already HIV-positive, and three of them didn't even take their medication properly. One other person in that study started the medication too late. So one might even say that PEP failure only happened in one or two people.
In all the other studies I have read, there was 50, 100, 200 people involved, and maybe one person sero-converted. And one of those studies with about 200 people, nobody sero-converted. So when it comes to the tests that have been done on postexposure prophylaxis, those are the accurate numbers. Not what that guy said above.
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crabman
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http://www.urbandictionary.com/define.php?term=necroposting
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To Crabman:
In case you hadn't noticed. This is a health forum. Just because a thread is several years old doesn't make it too old to respond to. The information is still health information. Whether it's 2004 or 2012. So your comment, snarky as it is, regarding necroposting, is inapplicable.
If the information posted above was correct in 2004, then you would have a point. It would just be outdated. But the fact is the information posted above was wrong in 2004. Just like it's wrong today. So responding to it, and correcting the misinformation, is not only important, it's imperative.
These threads still show up in Google search results, and I highly doubt that the average person takes note of the date when they digest the misinformation. This thread needed some accurate information, and I have provided it. You however, have contributed nothing of value to this thread.
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