Question
Does PEP delay seroconversion?
24 December 2021. Related: All topics, PEP/PEPSE.
Hi, I had an exposure in early October.
I took PEP (TDF + FTC + DTG) after 5 hours of the exposure. I did not accompany the doses with meals, I took them alone with water or some drink. Can this interfere or reduce its effectiveness?
Does PEP delay seroconversion in case of failure? At 5 weeks after finishing PEP swollen lymph glands in both armpit.
Answer
Hi, how are you doing?
PEP does have the potential to delay seroconversion.
As PEP works similar to medication used to manage HIV, PEP if unsuccessful can delay seroconversion.
This is why testing a minimum of 4 weeks after PEP is required. Seroconversion can occur 1-3 weeks after the course ends. Only 80% of those who do seroconvert in failed PEP will experience classical symptoms e.g., fatigue, fever, headache etc.
Five weeks after finishing PEP would be later than expected if this was really HIV. Swollen lymph nodes can arise from a number of infections, not only HIV. Is this symptom being managed by a doctor?
The combination you have taken can be consumed with or without food. This would not have impacted how well it worked as PEP.
If you have another question do ask,
Josh.
hi Josh,
I got exposed and started PEP within 72 hours of exposure however I had 3 more exposures with the same person while on PEP. the last exposure being 4 days before I finished PEP. immediately after completing PEP I tested negative and I started Prep..3 days after starting Prep I had sex with the same person again..now 2 days after our last encounter and five days since I started prep and finished pep I’m experiencing diarrhea, a headache and a sore throat…could these be symptoms of seroconversion of prep side effects?
NB: The person tested positive for HIV
Hi Joseline, I am sorry to hear about your partner, how is he doing? You do not need to extend your course of PEP. While on PEP you are protected from further exposures. PEP will act like PrEP during the course of treatment. The effectiveness of PEP will not be changed and you can finsh your course of PEP when originally planned.
Hi Dr.
I started PEP around 52 hours post exposure; I was just trying to be safe as my partner and I had not tested. Post starting the PEP, I was exposed three times while on PEP. Two days ago my partner and I tested, and he tested positive. I’m on day 9 of the PEP. How is the effectiveness of the PEP impacted by the exposures after I had started? Is there a need to extend the PEP treatment?
Hi KK, as you have mentioned it is possible that the ‘choking’ feeling you experienced was caused by swollen lymph nodes. This would not have been a side effect of PEP. As you experienced this so early in your course it is more likely this was caused by an infection prior to your exposure.
Only the first two medications you listed are used in HIV management/PEP. As the other 3 are supplements they would have had no impact in the prevention of HIV during your course of PEP.
These tests will not be conclusive. Viral load is suppressed when on PEP if you are HIV positive. Viral load is not a test used to confirm HIV status as it fluctuates. Western blot is a test used that identifies antibodies. PEP would have delayed this and antibody testing is not suitable until 3 months after PEP. The earliest test you can use to confirm your status is a 4th generation antigen/antibody test from 6 weeks post PEP.
Hi Josh, thanks for your response. No, I didn’t not have any treatment for oral thrush. It, itself, got better in two weeks or so.
Nausea almost remained all throughout the PEP course, some days it was more while some days it felt less.
You didn’t say anything about the “choked” feeling that I had almost all throughout the PEP course. Is it possible that I already had those swollen lymph nodes and that choked feeling was because of that? Or is it possible that whether the choked feeling lead to throat swelling or the swollen lymph nodes lead to that choked feeling but either way it could be because of the side effects of either of the PEP medicines which are as follows:
1. Tablet Tenvir EM
2. Tablet Daruvir
3. Capsule Sync Q10-Max
4. Tablet Turatab
5. Nimbadi Vati.
Also, can you please tell me if the hiv rash (when they do) starts appearing slowly or appears all of a sudden? Would I feel anything when I would about to start having HIV rash?
It’s 9th day since I finished my PEP, still no other symptoms than those three lymph nodes on the left side of my throat/neck.
I went to my doctor today. He didn’t even check my lymph nodes. He simply took my blood sample for the following tests:
1. HIV Viral Load test.
2. Western Bloat test.
He said symptoms doesn’t mean anything and these tests would be able to tell us the true story whether or not I have the HIV. I asked him if he thinks that the result of these tests would be conclusive as I’ve completed only 8 days after PEP. He said the results would be conclusive as these results are not based on antibodies rather on the actual HIV virus.
Your thoughts please?
Hi Thiaza, your results are conclusive. You do not have HIV and you do not need any further testing. Please follow this link for more information about testing and transmission: https://i-base.info/qa/factsheets/hiv-transmission-and-testing
hi, doc i was exposed to hiv 26 june 2022 and i started pep on the 28 june and finished my 28 day course on july 27. i went for my first test on 26 august 2022 and was negative and i also went for my second test on the 26 october, so i would like to know that is my results conclusive?
Hi KK, your initial infection of oral thrush is not associated with HIV. Oral thrush is a later complication of HIV infection and any initial sign of HIV would not present so soon after exposure. Did you have any treatment while you had oral thrush?
You are right that nausea is a common side effect of PEP. Did this settle throughout your course of PEP? The papules on your back are more likely to be normal. Having a few papules on your back is not uncommon for anyone.
The initial swelling you noticed in your neck after 2 days after PEP is not HIV associated. Similar to initial exposure, symptoms of seroconversion will not present so soon after PEP. PEP suppresses the normal sequence of HIV and seroconversion symptoms would not present until 2-3 weeks after PEP.
You have not noticed any further symptoms aside from 3 lymph nodes on the side of your neck. This is a very non-specific sign. This lone symptom is not suggestive of HIV. A number of symptoms would be expected to suggest HIV seroconversion. Have you had these lymph nodes examined by a doctor?
Please follow this link for more information about testing and transmission: https://i-base.info/qa/factsheets/hiv-transmission-and-testing
Hi, I was exposed to HIV and started PEP at 50 hours. Just after 2 days of PEP, I had oral thrush in my mouth on tongue, and inner walls of cheeks, which faded away in two weeks. Also, I used to feel somewhat like “choked” in my throat which I thought might be nausea, a common side-effect of PEP. 2 days after I finished my 28 days PEP, I noticed some swelling in the left side of my lower throat. One week after PEP I noticed two more swollen lymph nodes in the left side of my throat/neck. One is under my cheek bone and another one is below my left ear adjacent to the jaw line.
I didn’t have maculopapular rash but noticed few pimple like papules on my back after I was in 3rd week of PEP. They appeared one by one over a period of two-three weeks. Still having a couple of them.
No fever, no flu-like symptoms, no joint pains, no night-sweating, no chills, no other symptoms.
I have not had any HIV test yet as I’m waiting for 4 weeks to be completed after PEP. It’s just been 1 week after PEP so far. However, I’m really worried if the three lymph nodes in the left side of my throat/neck are HIV symptoms. I don’t see any other reason for these swollen lymph nodes for me. Please provide your honest thoughts on this and I hope you not to be comforting me but just the solid facts.
Hi KK, these are not suggestive of seroconversion. Your 4th generation test at 4 weeks is 95% accurate. Taking a second test at 6 weeks will be conclusive.