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 Francis, any test 6 weeks after PEP is conclusive. Given that all of your tests have already been negative it is very likely that you are not seroconverting. The symptoms you were experiencing the day after would have been too soon to the exposure to be caused by HIV.
I am sorry to hear you had a difficult time while on PEP, but given the symptoms are fading from this it is a good sign and that it was more likely caused by the medication than anything else.
How is your friend doing? If they have only recently found out their status they will need support from friends and family while they are adjusting to being HIV positive.
On 5th of April early hours about 2am had unprotected sex with a long time friend we spent the whole day together. Had a second exposure around 11pm the same day and went home…
The next day 6th I was feeling a little funny in the evening and put a call across to her about her status she said she was fine…the next day 7th I drove to look out for her got some test strips saw around 6pm of that day did the test to my surprise she was positive…I quickly rushed out to the hospital got pep around 9pm of 7th of April.
I really made a mistake of thinking that my healthy looking working class friend was std/hiv free.
I commenced PEP under 72 hours around 66hours mark…
Took pep regularly for 33days(added some days) ..it was an up and down symptom feeling throughout the pep course…esp tingling sensation on my legs , joint and muscular pain, dreams, bloating stomach, feeling unwell towards the end of the regime..
Some days After pep the tingling /peripheral sensation started reducing, muscular twitches even in my armpit, joint pains , itchy or pinching sensation, progressive fatigue. movement on my skin and I won’t see anything.
I have done test baseline test for HIV and all std which came out negative..another. After pep all negative…took another one today 40 days after exposure negative …
Am scared am seroconverting….is there anything I can do at the moment?
Hi Prince – I cover this service while Josh is away. PEP is usually really effective and very few people test positive after using PEP. If you are anxious, take a 4th generation test after 3-4 weeks – the negative results might make you feel better. Then confirm this a few months later. Stress can cause all the symptoms you describe.
Hi,
Josh this is Prince,
Finished my pep regime(30days) and tested with Alere Determine HIV 1/hiv2 ab/ag it was NEGATIVE….is this a good sign.?
…after pep am still feeling those my initial symptoms intermittently muscular twitching, joint pains, burning sensation on the tongue, small movement or armpit vibration, pinching or movement sensation on my body, mild generally feeling unwell
My big question is Pep specific to HIV prevention can any underlying issue cause PEP failure….am asking what i feel now has always been there before my exposure( and I have raised a healthy family) just that it spikes more …I want to relate that because of the pressure of PEP on my body immunity and system…
Am scared to go through this feeling and anxiety for the next few months to get another test. Because this feeling is just like flu like symptoms…
Pls help
Hi Victor, thanks. It sounds much better to take the test before you so so you are not worrying. If this is a 4th generation Ab/Ag test then you don’t need to retest, but if it is a 3rd generation antibody only test, then confirming the result a few months later is recommended.
Hello, can I take a test at day 40 post PEP and consider it conclusive? I will be out of the country for 3 weeks and I don’t think I can handle the anxiety during the trip, which I expect to enjoy. The 6 weeks mark is at day 42, but I want to make sure it is highly unlikely to change because of a difference in two days
Hi Ivan, thanks. It sounds like you have done everything right and PEP is usually very effective. The symptoms after PEP do not means this was HIV. Taking the HIV test is needed to know this. If the symtoms were HIV though, then taking an HIV test now would tell you this. IF the result is negative, the symtoms were not HIV, but you still need to test again later.
Hi ,
I hope this message get you well, I had sex but don’t know her status, but let assume that she was positive. Our the condom broke and after 48 hours I went on PEP. During that time after exposure my test was negative, then I’ve completed the full 28 days with PEP (Renega pilks).
A week later after finishing PEP, I had flu altogether with a sore throat, then my body is itching.
So I haven’t done any test so far but I will do it a month from now, can we conclude that these symptoms can be related to the HIV or should this can related to something else ? I’m a bit scared .
Dear Kavumajamil, please use this experience to learn more about HIV. Instead of panic, and rushing to get ARVs, you should know that an undetectable viral load means that you might not be at any risk.
In the UK you would not have been given PEP. Maybe go back to your partner and apologise for your reaction?
Also please see info at this link:
https://i-base.info/u-equals-u/
Am kavuma Jamil from Uganda I have protected sex with my sugar mom only one time,afterwards i rejected condom but I noticed she was on Arvs treatment.i rushed to the hospital and got pep at 9th hour have just completed a dose butt am so scared