Q and A

Question

How long should HIV ARS last when PEP medication fails?

Hi,

How long should HIV ARS last when PEP medication fails?

I had a high-risk exposure with an HIV+ CSW when the condom broke. I developed a bruise after the condom broke, due to poor lubrication, which increased my risk.

I started PEP at six hours post exposure (TLD). I received 30 tablets and took them all religiously. However, after 16 days, I developed headache, diarrhea, night sweats, swollen lymph nodes in the groin, abdomen and neck, as well as body aches. The diarrhea stopped on day 18. On day 21, I developed a dry cough which was accompanied by an irritating sensation going deep down in the chest. On day 24, the irritating sensation whenever I coughed expanded to include the throat.

On day 31, after completing the PEP dose, I went to a hospital for an HIV text, which came back negative.

However, on day 33, the headache, swollen lymph nodes, and body aches intensified significantly and I also developed some minor chest pain. On day 35, I noticed a white spot at the back of my throat. Today is day 36; the cough has subsided but still lingers a little. However, the headache, lymph nodes and body aches remain significant.

I am certain that the PEP failed and that I am undergoing HIV ARS. My question though is, how long should the ARS last? I have read that HIV ARS lasts one to two weeks but this has now lasted three weeks.

This bothers me because I feel as though I contracted a really bad variant of the virus, for which the body is taking longer than usual to complete the seroconversion. I intend to go ahead and start my ARV treatment but the hospital will not give me ARV treatment before the tests turn positive, which can only happen after the ARS ends. Is it common for people to experience HIV ARS for longer than three weeks?

Answer

Hi, how are you doing?

As you have mentioned, ARS can last from a few days up to a few weeks. For most, 2 weeks is the earliest that ARS will resolve. It is not uncommon for ARS to last longer than this.

Your doctors are right not to start you on ART yet. As you do not know if you are positive, ART can suppress how tests work in the earliest stage of seroconversion. This is for the same reason that testing while on PEP is not accurate.

Starting treatment now may mean you are starting treatment that is not suitable for you. Waiting these few weeks will not have a harmful effect on your health.

Why have you considered your exposure with this CSW as high risk? As you started PEP so soon it is much more likely that it was effective. There are many infections/illnesses that can cause the same symptoms you are experiencing – a big one in this case is stress.

Another factor could have been a poor reaction to PEP and you are experiencing side effects. Have you been able to discuss with your doctor any other causes for your symptoms?

Please see this link for more information about PEP:
https://i-base.info/qa/factsheets/pep-faq

Josh.

40 comments

  1. Simon Collins

    Hi Eny, please see the link here are PEP:
    https://i-base.info/qa/factsheets/pep-faq

    This service doesn’t answer individual Q on PEP that are answered at this link.

  2. Eny

    Hi
    The faint line described earlier was actually not a faint line as the lab senior person showed me in subsequent test. The initial test was done by a new person in Lab. Ve done series of tests with different kits in different labs since then. But since 67 days post PEP last Saturday, I’ve had a fever for 4 days today, which I refused to treat cos I’m on a fasting. Today, 10 weeks post PEP, I took Abbott ab test negative, hbasg negative yesterday, MP negative. Fever relieves for certain hours in a day. No rash, no respiratory concern, no mouth issue, still bath very cold water. Normal feverish pain in head or neck, mild muscle pain. Please why all these by 10th week post PEP. Neck, groin, armpit glands intact. Isn’t 10 th week post PEP supposed to be rather just confirmatory than concerning

  3. Simon Collins

    Hi Gaurav, your Qs about symptoms together with other info about PEP including testing is here:
    https://i-base.info/qa/factsheets/pep-faq

    You should not be using PEP unless you had an HIV test beforehand. If you didn’t test then your doctor has not treated you properly. Actually, you risk sound so minimal and smal that you would probably not have been given PEP in the UK.

  4. Gaurav

    Hi,

    I sused a lot of oil having sex and my condom slipped and i inserted my penis once without condom. Afterwards i removed my penis and used a new condom.

    As i was scared i searched on google and went to a Dr, he prescribed with PEP medicine i.e. Tenvir EM , Virem R, Turatab, Sync – Q Max, Atoxyliv medicine and i took those medicine diligently for 30 days. I took 1st dose of Virem R 19 Hrs post expose & then corresponding doses after 29 Hrs of exposure.

    I had few symptoms of lethargy, pain & feverish feeling ( no fever) 1-2 weeks after staring PEP but they resolved by 3rd week.

    Between Week 3 & 4 post PEP medicine i had really bad sore throat & pain which resolved after 10-12 days but now in Week 9 i have headache ( no sore throat now), i feel my throat lymph nodes are swollen ( Could be my imagination also as i am scared) & muscle pain ( I also do intensive gym).

    I am afraid of taking HIV test, pls advice me.

  5. Simon Collins

    Dear Eny, PEP is vary effective and this sounds like you need to repeat the test and to maybe do this at a test centre.

  6. Eny

    Despite taking PEP within 40 mins post exposure adherently for 28 days, for condom break with immediate withdrawal twice in one event, today being 50th day post PEP, antibodies test brought a very faint line T.

  7. Josh Peasegood

    Hi Mukesh, as you started PEP so soon and these symptoms began while on PEP it is very unlikely that they are the result of seroconversion. PEP, even if it fails, delays seroconversion until a few weeks after the last dose of PEP. Your symptoms have started far too sign to be suggestive of HIV.

    As you had been using a condom, even though it broke and are unsure of this persons HIV status it makes the risk relatively low.

    You should not be starting any HIV treatment until after you have a confirmed result. This can be as early as 6 weeks after the last dose of PEP using a 4th generation antigen/antibody combo test.

    PEP does not protect you from common infections like the flu or covid which are both able to cause the same symptoms that you have mentioned. Is the chest pain normal for you? As with any chest pain it would be recommended to have this checked by a doctor as soon as you can.

    For more information about testing and transmission please see here: https://i-base.info/qa/factsheets/hiv-transmission-and-testing

  8. Mukesh

    PLEASE TELL ME ABOUTS THIS PEOPLE ARE YOU CONTACT AGAIN HE IS POSITIVE OR NOT PLEASE PROVIDE ME SOME IMFORMATION.
    BECAUSE I AM ALSO SEE THIS TYPE OF SYMTOMS

    Hi,

    How long should HIV ARS last when PEP medication fails?

    I had a high-risk exposure with an HIV+ CSW when the condom broke. I developed a bruise after the condom broke, due to poor lubrication, which increased my risk.

    I started PEP at six hours post exposure (TLD). I received 30 tablets and took them all religiously. However, after 16 days, I developed headache, diarrhea, night sweats, swollen lymph nodes in the groin, abdomen and neck, as well as body aches. The diarrhea stopped on day 18. On day 21, I developed a dry cough which was accompanied by an irritating sensation going deep down in the chest. On day 24, the irritating sensation whenever I coughed expanded to include the throat.

    On day 31, after completing the PEP dose, I went to a hospital for an HIV text, which came back negative.

    However, on day 33, the headache, swollen lymph nodes, and body aches intensified significantly and I also developed some minor chest pain. On day 35, I noticed a white spot at the back of my throat. Today is day 36; the cough has subsided but still lingers a little. However, the headache, lymph nodes and body aches remain significant.

    I am certain that the PEP failed and that I am undergoing HIV ARS. My question though is, how long should the ARS last? I have read that HIV ARS lasts one to two weeks but this has now lasted three weeks.

    This bothers me because I feel as though I contracted a really bad variant of the virus, for which the body is taking longer than usual to complete the seroconversion. I intend to go ahead and start my ARV treatment but the hospital will not give me ARV treatment before the tests turn positive, which can only happen after the ARS ends. Is it common for people to experience HIV ARS for longer than three weeks?

  9. Josh Peasegood

    Hi Johnsine, there has been no documented case of transmission via a splash in the eye. There is no risk of transmission from your case. Who recommended that you start PEP?

    Please see here for more information about transmission: https://i-base.info/qa/factsheets/hiv-transmission-and-testing

  10. Johnsine

    My name is johnsine i am exposure by during administration of medication on canula splashe to my eye and the patient she hase HIV posetive and she used treatment.now me i take TDf PEP with 8 hour after exposure and i used correctly .how much the percentage of exposure