Question
Is PEP effective if taken 48 hours after exposure?
2 July 2021. Related: All topics, PEP/PEPSE.
I paid for sex with a woman but the condom tore and I only realised after I was done. There is a high chance that she was HIV positive. I started PEP after 48 hours.
I got a PCR test done 17 days after exposure. It had a less than 20/ml (undetectable) result.
Now between 14 and 35 days after exposure I have had signs of thrush, mild red rash on my face and a couple elsewhere. But no fever or swollen lymph glands.
Can the rash and thrush be because of utter stress and obsession?
My doctor says that the PCR can be relied upon and that I am negative.
Can the PEP have reduced the viral load to less than 20/ml as I took it for 15 days before the PCR test?
Please give your expert advice. I am very anxious. Thank you.
Answer
Thank you for your question.
The risk of HIV from one broken condom is very low. If your partner had an undetectable viral load on treatment, then the risk would be zero. If they were not on treatment the risk might still be only 1 in 300 or lower.
You cannot guess someones HIV status so your assumptions might also be wrong.
You started PEP within 48 hours, so it is likely it will work.
PEP – stands for Post-Exposure Prophylaxis. It is a term used for taking HIV drugs to reduce the risk of infection. PEP usually involves taking a combination of three HIV drugs for one month. The earlier PEP is started, the more likely it will work. Ideally, this should be within a couple of hours. If this is not possible, then still the earlier the better.
Some guidelines include a two-day window to do this (i.e. within 48 hours). After this, effectiveness is much less likely. Other guidelines allow up to 3 days (i.e. within 72 hours). Sometimes this may be more for psychological benefit. For example, if someone is very stressed or traumatised.
No guidelines recommend starting PEP after 72 hours.
After finishing PEP you need to wait a 4-6 weeks before testing.
If the PEP has worked, or the person was not initially infected, this will show as a negative HIV test. The test you did 17 days after the exposure will not be accurate yet.
If the PEP has not worked, this will be shown in a positive test result. Testing 4 weeks after PEP will detect 95% of infections. Testing after six weeks will detect more than 99% of infections. This result doesn’t need to be tested again.
If PEP has not worked, serosonversion usually occurs 1-3 weeks after PEP is finished. However, only 80% of people show symptoms.
Please test 6 weeks after you finished PEP is finished. If you test any earlier, you need to take a second test 3 months later.
Viral load (PRC) tests are not approved to test for HIV. In some cases they can have a role.
Please see a doctor to talk about your symptoms he best way to confirm what is causing them is to see your doctor. He/she will be able to diagnose and treat the symptoms accordingly.
Please see this link for more information about PEP:
https://i-base.info/qa/factsheets/pep-faq
Note: This answer was last updated in July 2021 from an original post from December 2011.
Hi Justin, please see this QA on when PEP can sometimes act as PrEP. Please also talk to your doctor about PrEP.
https://i-base.info/qa/19541
If you are on 15 day of taking PEP, and u get into unsafe sex and you realize the person is HIV negative, you complete that dose of PEP, or you start a fresh another dose of PEP,
Dear anonymous. If you bite people living with HIV, please don’t expect other people living with HIV to help you afterwards.
I had a fight with someone and bite her, and she happens to be on ARVs, i tested negative and Dr gave me pep in 19hrs,i jus finished my pep and 2 days before finishing i developed an itching and reddish swelling a lil in my genitals, what could this means?
Hi there
I am really sorry to hear about what happened to you.
PEP is very effective at preventing HIV and you started this in plenty of time. You do not to worry about HIV on top of the other trauma.
Please also ask about counselling and support to help you deal with such a terrible experience.
I’m hopeless ☹️ and angry. I was raped. I started my pep at 19hours can somebody please tell me I will be fine the pain is too much.
Hi Jax, I am sorry to say but if you took PEP a week later after the exposure, PEP would have had no effect. There would have also been no benefit from increasing the duration of PEP from the recommended 1 month up to 2 months.
You can test using a 4th generation antigen/antibody test from 6 weeks after your last dose of PEP.
Please follow this link for more information about testing and transmission: https://i-base.info/qa/factsheets/hiv-transmission-and-testing
I used a condom but it slipped off and my partner was needed so she went and came back after a week and to test…oooh Gosh , she was positive
I immediately went to get PEP and took if for two months but honestly I fear to go for a test
Advise legally please
Hi Prince, there are a number of factors that change someones risk of becoming HIV. In your case there are a number of preventative factors that you have taken that will reduce/prevent transmission. Starting PEP within 48 hours is excellent and this is when it is most effective. Being male/the insertive partner further reduces your risk of transmission. Initially using a condom, even if it slipped off prevented the total time of exposure.
The rash/bumps you have mentioned could be caused by a number of things. It could be connected to your already known undiagnosed condition, it could be something new, a possible side effect from TLD or it could even be caused by stress. Have you mentioned this new rah to your doctor?
It is a good sign that you have tested positive however using the test that you have, you will need to wait 6 weeks after the course of PEP for this to be conclusive. This is a link about dealing with stress/anxiety around testing: https://i-base.info/guides/testing/hiv-testing-feelings-of-fear-anxiety-and-guilt
Hi Josh,
Thanks for your remarkable response.
I have been on this for a long time now.had an unconfirmed exposure over 11 years ago. Which lead to flu like symptoms body rash mostly on my thigh, white hairy tongue, burning sensation on my tongue, progressive small bumps on my upper lips non painful, non blister they are still intermittently ongoing..done several HIV test which came out negative got married with healthy children
.
Presently, had vaginal sex with a now known HIV positive woman.-had to go back and confirm with a Alere test strip- we started with condoms but it slipped out thought it was still there had about 50 stokes till I ejarculated and noticed washed off and tried to urinate. She is positive and untreated. I confirm her status 40hours after exposure due to her unavailability. I commenced PEP about 45 hours after exposure.. Today is my 7th day on PEP am dedicated to finish the prevention course..
Am scared because whatever is my previous condition will likely expose me faster to the HIV exposure meet so many docs as regards my previous conditions which is still ongoing no diagnosis. Since I start PEP I have only notice about 50new rash bumps on my right arm..could this be as related to the TLD PEP regimen? I did an Alere Determine Hiv1/2 Antibody Test before commencing PEP what are my chances of remaining negative? Pls help JOSH