Q and A

Question

Did PEP work?

3 April 2023. Related: All topics, HIV transmission, PEP/PEPSE.

Hi there!

I have sex with a sex worker and the condom failed. I am unsure of her HIV status. However I stated PEP around 40 hours after the exposure.

The PEP I was prescribed was Tribuss. I am worried that this was the incorrect PEP to be given due to drug resistance.

Anyway I found out I got chlamydia during this exposure. I completed the PEP and a course of Doxycycline for the Chlamydia. Then the day after I finished the two weeks Doxycycline, I started getting a white tongue. I also believe I have muscle aches however they are not painful. The white tongue and muscle aches started 10 days after finishing PEP.

Also on the 10th day I did a self test blood antibody test, which came back negative. I will test again on day 40 after the last does of PEP, but I am very worried about these symptoms.

Will the Tribuss work? Should I be worried about these symptoms? Thanks,

Steve

Answer

Answer: Josh Peasegood

Hi Steve, how are you doing?

Why do you think there is drug resistance? Atripla is not recommended as PEP. This is more a result of the potential side effects of Atripla rather than its ability to prevent HIV transmission.

Atripla contains efavirenz. This drug can cause mood disturbances which is the reason it is not offered as PEP. As you have completed the course of Atripla for at least 28 days Atripla would have still been able to prevent HIV transmission.

Is there a reason you think this sex worker is HIV positive?

A white tongue can be caused by doxycycline. The antibiotic can put you at risk for other infections while you are taking the course. Have you mentioned this to your doctor?

Have you noticed any other symptoms aside from the muscle aches? and if they are not painful do you know anything else that could have caused this e.g., more exercise, increased tiredness, dehydrated?

A self test antibody test is only accurate from 90 days after the last dose of PEP. You can use a 4th generation test. These look for antigens and antibodies. These tests will be accurate from 42 days after the last dose of PEP.

You should not be worried about the symptoms you have in relation to HIV. The white tongue is likely explained by doxycycline and muscle aches are common and alone they do not suggest HIV.

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

Josh.

19 comments

  1. Josh Peasegood •

    Hi Steve, as it has been more than 6 weeks since your last dose of PEP you can now test using a 4th generation test. This result will be conclusive.

    A hairy tongue is not an early sign of HIV. It is most commonly seen in people living with HIV without treatment. It occurs when the immune system is damaged. It is too early for your immune system to be damaged that this would be the result of HIV.

    Joint pain and muscle aches are very common symptoms. These symptoms are very non-specific and are not suggestive of HIV.

  2. Steve •

    Hi Josh and Simon,

    My course of PEP finished on the 12th of March. My tongue started going hairy / white on roughly the 24th of March.

    Currently on the 1st of May roughly 38 days since my symptoms began I still have a white hairy tongue and now my Lymph nodes under my jaw are swollen…! I never had any fever, colds, night sweats.

    I did about a month ago maybe had minor joint pain and muscle aches.

    I am really not looking forward to having my HIV test!!

    Is it normal for acute symptoms to persist this long?

    Best,

    Steve

  3. Simon Collins •

    Hi Steve, there is never any urgency to test once it has been more than 2-3 weeks after a recent a recent exposure. The link I posted before has more info on seroconversion.

  4. Steve •

    Hi Simon,

    Thanks for the quick response, especially on Sunday..!

    I am currently away with work and will be for another 5 weeks or so. Unfortunately during this time I will not be able to test, so I can just stir worrying about this until I’m home..!

    I do want to thank you for this service it’s great to be able to talk to somebody who is an expert in HIV related questions.

    Simon how concerned should I be with the symptoms I’m experiencing?

    Thanks,

    Steve

  5. Simon Collins •

    Hi Steve, if you are worried about HIV, please take an HIV test. Please also see the info and links at this post:
    https://i-base.info/qa/11844

  6. Steve •

    Hi Josh,

    With the symptoms I have told you and given they have persisted for so long, especially the white tongue.

    My aching Joints are subsiding but I still have a white tongue and sore lymph nodes in my neck, they are not hugely swollen though, I cannot see them through my skin.

    Would you say I am experiencing Acute HIV?

    Thanks,

    Steve

  7. Josh Peasegood •

    Hi Steve, thanks for the update. Please see here for the duration of symptoms and seroconversion: https://i-base.info/guides/testing/symptoms-and-seroconversion

    The symptoms you are experiencing can be caused by a number of things. As you have noticed them at different times and they are all lasting for different durations they may be the result of one thing or could be a number of things at once. As I am not a doctor I cannot suggest all possible causes for these symptoms and this will need to be a discussion with your doctor.

  8. Steve •

    Hi Josh,

    Thanks for the calming of my Nerves. I am however still stressed, definitely seems to be a very tough point in my life and this is before even knowing if I for certain have HIV or not..!

    I just want to update you on my symptoms. I am now 30 days past my last does of PEP. The symptoms which I have been having is swollen glands in my neck.

    I have aches in my finger joints, my knees and hips are sometimes clicking.

    I have what seems like a rash on my hands, it’s a mild rash which appears to be underneath my skin completely covering my hands a blotchy mild red pigmentation. This is not raised and seems to come and go throughout the day depending on temperature and how much I use my hands.

    I have also had a white tongue which seems fuzzy on the top of my tongue for coming up to two weeks which does not seem to want to disappear..!

    I’m currently traveling for work and will not be able to see a doctor or have another test for 6 weeks..

    If acute HIV was causing these issues how long will the;

    • Joint pain Persist
    • white tongue persist
    • rash on hands persist
    • swollen lymph nodes persist ( these are already feeling my better, they just felt slightly sore but not raised enough to see through my skin)

    Also do you know of any other STI’s which could cause all of these issues?

    Thanks again,

    Steve

  9. Josh Peasegood •

    Hi Steve, HIV has not developed a resistance. Resistance to these drugs are rare and to be resistant to both would be even more uncommon. Resistance most commonly occurs in poor adherence in HIV positive people and their own HIV has the chance to develop resistance. This is much less common in the general population. This is why triple therapy is used to account for the possibility of resistance so at least one drug within the combination will be effective.

    Even though this woman is a sex worker in South Africa it still remains more likely that she is HIV negative. There is no reason to doubt what this woman was saying. Often people involved in sex work are more aware of their own status given the nature of their work.

    Having a concurrent STI can increase the risk of HIV transmission but not significantly. Transmission is affected by multiple factors and it isn’t easy to say which factors will have greater risk in the individuals own transmission. More about this is found here: https://i-base.info/guides/testing/risks-for-transmission

    As for the antibiotics and tongue you will need to speak with your doctor. At i-base we are not doctors and are not suited to giving advise with other treatment.

  10. Steve •

    Hi Josh,

    Thank you very much for your quick response, I was under the impression that HIV had built up a resistance efavirenz and Atripla.. maybe this is spending too much time panicking and looking through the internet! (I did have bad side effects with the PEP and my mood but persisted through these)

    The the main symptoms I am having is white hairy looking tongue, this covers the entire of the top surface of my tongue. After I use a toothbrush and brush it for a minute the white complexion looks almost normal, but you can still see the “hairy” surface. The back of my tongue is harder to get to so looks worse. I used Daktarin for 5 days and this did not help. This tongue has been here for around 8 days now.

    The other symptom I am having is having fleshy bits on the underside of my tongue. These are very small however something I have not noticed before.

    How long would this last after stopping antibiotics? I also emptied the last does of antibiotics in a drink (for some unknown reason), would this increase the chances of white tongue?

    My reason for thinking the sexworker was HIV positive is because she was a South African sex worker in South Africa. When asked she has said she was HIV negative..

    I was also under the impression that if I caught a STI being Chlamydia this would greatly increase the chances of catching HIV? I would like to highlight this is male to female vaginal sex.

    Thanks,