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, thanks for your response on my earlier question. What I’m really trying to figure out is whether or not PEP medications (which works similar to ART) when fails, has the potential to make HIV undetectable for more than 90 days after the completion of PEP course? Has there been any such case in the history of medical science where someone who tested negative in a 4th generation test after 90 days of completing PEP, came positive in another HIV test later than 90 days of PEP (with no further risk involved ofcourse)?
I know you have been telling us over and over again that a 4th generation test is 99% accurate from day 42 after PEP but even after I was tested negative in multiple 4th generation tests done during throughout the period of 4th week after PEP to 90 days after PEP, I still don’t feel well enough. My Herpes got reactivated twice in two weeks, I have swollen lymph nodes in my neck, groin and armpits, my chest is having a little rash and my back is stiff and aching, over all I feel very low. So, I’m afraid that there could be a chance (even the rarest one) that I might have HIV and PEP might have made and kept it undetectable so far and after a couple of months my test might show a positive HIV result.
So, please tell me Josh is there even a slightest/rarest exception that I might be right and PEP could keep HIV undetectable for even more than 90 days of PEP?
I don’t want to be 99% sure of my HIV status. I want to be 100% sure. So, what is the maximum time to get a 4th generation HIV test to have 100% accurate result with no exception at all of any kind?
I would really appreciate your detailed response on this Josh. Please help me with the reference of exceptions and facts and make me aware of the maximum risk please.
Hi Edward, RNA tests are not used to diagnose HIV. Earlier testes are less accurate. These types of test are more suitable for monitoring after an established diagnosis. The earliest confirmatory test you can use is a 4th generations test after 6 weeks from your last dose of PEP.
Seroconversion symptoms are not always guaranteed. Around 20% of people will have no symptoms. They are also very non-specific and can present similarly to a cold/flu. While less common, it is possible to have symptoms of seroconversion with an undetectable viral load. The body will still mount a response towards HIV and this is what causes the symptoms.
Dear Josh and Simon,
Thanks for all of the questions answered to all these people, you are light to many people that maybe not commenting or asking but reading.
Sometimes doctors are very straight forward and leave us with many questions.
I have a complex scenario and I would appreciate a lot if you could provide me with some lights.
I had receptive anal sex with a sW of unknown status
I was recommended to begin pep (triumeq) but maybe too late 7th day because I began what I consider symptoms at day 5 (pain in elbow knee and hand).
During the course of pep I developed mild acne On forehead and chest(Second Week). Then at the final week I developed swollen lymph nodes near ear and neck but at this time the initial pain was resolved. I had 4th generation tests all those weeks since 1 to the last day of pep and were non reactive.
2 days after ending pep I began experiencing again some pain in my hands, knees and now my lymph nodes are more swollen and my throat is sore. I took a RNA load level test 5 days after ending Pep (which would detect at least 40 copies) and resulted negative.
I have read that RNA tests are very accurate and sensitive and in many escenarios could detect very early but maybe it was too soon after ending pep.
My first question is if RNA viral load could be reliable after 5 days pep but symptoms? I assume that if someone has symptoms they should have a detectable viral load.
I have also read that seroconversion symptoms usually occur when viral load is high. Is it possible to have undetectable viral load and have these symptoms?
Thanks for your time and help
Hi KK, when you stop medication there is no definitive time that you can say you are still undetectable. In most people viral load will become detectable again after a week without treatment. But this cannot be said for certain with everybody. To say you have a durable undetectable viral load you need to still be taking treatment.
Hi Josh, thank you so much for providing your valuable guidance.
I have one question for you. When an HIV patient with “durable undetectable viral load” stops HIV medicines all at once, what is the maximum time that we can say with complete certainty that his viral load has to become detectable again for sure? I want to know the maximum period (even in the most exceptional case) to become detectable again from “durable undetectable” please.
Hi Ben, from what you have described there is no risk of transmission. At no point were you exposed to HIV. Please follow this link for more information: https://i-base.info/qa/factsheets/hiv-transmission-and-testing
Hi how are u
I was exposed to someone with hiv I rubbed my penis around her vigina but not inside the hole vagina
We had sex I used a condom and it didn’t break but I touched the condom afterwards this happened on the 2of december around 20:00 the next day I went to the hospital I was given acriptega to prevent hiv I I started taking the medication around 23:00 that day.
Fast forward after almost 3 weeks my sister was having a bad flu I started having flu accompanied with sore throat and and heavy shoulders stiff neck which had small limp nodes which I cant even see on the mirror after a week and half the flu went away but my neck was stiff and the shoulders till like today it’s no longer stiff and the lymph nodes are still small as they where.
Around 1-2 January finished my acriptega right . After about 2 weeks started having a bit of itchy rash on face and chest ,the rash is still there but increasing ir itching and now I’m accompanied by some pain in my knees and fingers face is it seroconversion
Hi Jose, when someone is undetectable they are unable to pass on HIV. There is no risk of transmission from this exposure. Please follow this link for more information: https://i-base.info/u-equals-u/
Hey I had sex with a guy who was undetectable and I got nervous after thinking about it so much started pep for 7 days I finish but feel like I still ended up getting hiv
Hi KK, a 4th generation test is conclusive from 42 days. Your test done at 90 days is accurate and you do not have HIV. Please follow this link for more information about testing: https://i-base.info/qa/factsheets/hiv-transmission-and-testing