Question
I was late and had unprotected sex while on PEP.
22 February 2023. Related: Adherence, All topics, HIV transmission, PEP/PEPSE.
I have been following this website for so long and appreciate all your help with people who need help like me. I am on the 28th day of my PEP course (Acriptega) and I would like to seek for your confirmation.
I took my first pills 24 hours after first exposure and keep adherence well until day 15. I accidentally took two pills 12 hours apart. I realised and went back to my normal schedule at 9am. On day 23 I was late by 3 hours then have unprotected sex. On day 24 i have unprotected sex again and after late 9 hours for the next pill. On day 25 I lightly vomited after 1 and a half hour after taking Pep and I didn’t take another pill. Since then I have stuck well to timing. I know it is really a mess up last week and I am scared now.
Please advise if i am still safe and do i need to extend by course.
I am a man and had all exposure with women.
Thank you
Answer
Hi, how are you doing?
No. You have not messed up how well PEP is going to work. As the doses you were late with were after day 21 there is going to be minimal impact, if any, on your treatment.
Taking 2 pills 12 hours apart of day 15 is going to have no effect.
The unprotected sexual encounters would have still been protected by the PEP in your body. PEP has a long half life – this means it can remain working in your body for a few more hours after the 24th hour.
Vomiting on day 25 an hour an a half later will not be a problem. At this point most, if not all the medication will be absorbed. There would have been no need to take an additional pill.
You do not need to extend the course of your current treatment. You can finish when originally planned.
Josh.
Hi Amit, your test will be accurate after 12 weeks. This lymph node will not have been caused by HIV. A swollen lymph node can be caused by a number of things. If it does not go down/you notice any other symptoms, please speak to your doctor.
Hey josh again !
Today i noticed an swollen lymph node in my right armpit. Should i worried for it ? Was my test accurate at 12 weeks post pep ?
Hi Amit, no this change of number does not matter. The result is still negative. You do not need any further testing.
Hi again josh !
I had taken another test 12 week post pep with an 4th gen combo test in a lab and it came as non-reactive. But as compared to my 6 week post pep result s/co value increased to 0.27(current) from 0.07(on 6 week). Is this is a matter of concern ? Am i clear of both hiv-1 and hiv-2 or should i take another test at 6 month mark ? Your help will be highly appreciated
Hi Amit, yes the 4th generation test can detect both HIV types 1 and 2. PEP works against both types.
Thanks for the response josh !
One thing more ! Does this 4th gen test also rules out hiv-2 also, I had read some articles that shows that hiv-2 progresses slower and thus antibody can’t be detected on test as early as hiv-1. Also does pep works against hiv-2 also? or it only works against hiv-1.
Hi Amit, you do not need any further testing. Your 4th generation test you had on day 43 post PEP is conclusive. You are HIV negative. Please follow this link for more information: https://i-base.info/qa/factsheets/hiv-transmission-and-testing
Hey Josh !
I had unprotected vaginal sex with a sex worker in india on nov 28th 2022, though all the time the condom was on but during the last 10-15 sec, i removed it and ejaculated in her, I don’t know her status, but started pep on 15-16th hour with (tenofovir disoproxil fumarate + dolutegravir + lamivudine) regimen and strictly adhered to it. I tested negative on the 43th day post pep with a 4th gen ab/ag lab. But yesterday i had runny nose and heavy head. Am i infected, should i go for one more test ? your answer will be highly appreciated
Hi Julian, Truvada and Descovy are the only combinations licensed to be used as PrEP. While other combinations may work, there is no information to say how effective it will be.
Thank you for your elaborate answer.
I reviewed the calendar and see on day 21st (not 23rd) which i was late by 3 hour. Hope that is still no effect on my PEP course.
My last question is that if i could from now on use On-demand prep for any heterosexual followed by 2-1-1 with any generic Emtricitabine / Tenofovir? Because it is difficult to buy Truvada from my country. The most popular is Mylan’s ones.
Thank you and best regards.