Aa
ARS
Dr: I had unprotected (protected then unprotected) insertive anal sex with someone HIV+ (the person said they tested regularly and were N). I convinced the person to get tested = result was + (no information on viral load). I tested N (no other stds). I was in the U.S. and was prescribed PEP which I started 12 hours after exposure (Truvada + Isentress). I completed course today (except for one 2 hour delay I took medications on time).
I have developed ARS symptoms. I live in a country where I will be deported on a + test, aside from family devastation. I will get tested as soon as I can, but I need professional help on (I know symptoms of little use). I cannot access PEP Dr, so I am writing to you.
26th DayAfter exposure: Abdominal pain, diarrhea, fever (100.4-101.4F all night, 99.3-100.4F following day. Ended 24-30 hours from onset. Stomach pain subsided after 1 day, diarrhea after 2. I also felt muscle pain in back and thighs, which went away with fever. Took Flagyl as I suspected a stomach bug.
28 day: Horrified to see rash on back and sides of trunk. Does not resemble eczema but red spots (raised with a red/dark dot in middle) other macular spots. Not closely clustered and redness does not extend from them but 20-30 interspersed on back and sides. I saw Dermotolgist who diagnosed 2 unrelated rashes: contact dermatitis and molluscum. I inquired if these are seen in ARS - he said no (became evident he had little knowledge when he disputed a rash on the trunk can be symptom of ARS).
Given my extremely stupid high-risk behavior and symptoms, I feel I have high likelihood of infection.
1. Does fever <2 days indicate this is not ARS or do other symptoms + PEP mean short duration of fever is not material? Would PEP delay and reduce severity of ARS? I know knowledge is limited but your view please?
3. Are gastro issues symptomatic of ARS? Are my symptoms highly suggestive of ARS? I could send picture of rash if way to do so. Thanks!
I have developed ARS symptoms. I live in a country where I will be deported on a + test, aside from family devastation. I will get tested as soon as I can, but I need professional help on (I know symptoms of little use). I cannot access PEP Dr, so I am writing to you.
26th DayAfter exposure: Abdominal pain, diarrhea, fever (100.4-101.4F all night, 99.3-100.4F following day. Ended 24-30 hours from onset. Stomach pain subsided after 1 day, diarrhea after 2. I also felt muscle pain in back and thighs, which went away with fever. Took Flagyl as I suspected a stomach bug.
28 day: Horrified to see rash on back and sides of trunk. Does not resemble eczema but red spots (raised with a red/dark dot in middle) other macular spots. Not closely clustered and redness does not extend from them but 20-30 interspersed on back and sides. I saw Dermotolgist who diagnosed 2 unrelated rashes: contact dermatitis and molluscum. I inquired if these are seen in ARS - he said no (became evident he had little knowledge when he disputed a rash on the trunk can be symptom of ARS).
Given my extremely stupid high-risk behavior and symptoms, I feel I have high likelihood of infection.
1. Does fever <2 days indicate this is not ARS or do other symptoms + PEP mean short duration of fever is not material? Would PEP delay and reduce severity of ARS? I know knowledge is limited but your view please?
3. Are gastro issues symptomatic of ARS? Are my symptoms highly suggestive of ARS? I could send picture of rash if way to do so. Thanks!
MEDICAL PROFESSIONAL
Hello and apologies for slight delay -its been a frantically busy week for us.
I do think it is unlikely that you will have acquired HIV from the episode you describe and the accepted risk is of the order of 1 in 1667 with the other party being HIV positive. Being circumcised will reduce the transmission rate from HIV+ female to male by a sizeable factor and that might be operative in anal sex as well.
PEP will have reduced the chances of acquisition by a further factor of approx. 80% or so.
It would be very unusual to have ARS signs whilst taking PEP as the whole rationale is to suppress HIV viral activity and thus prevent HIV replication. ARS will depend on replication - no replication = no ARS.
Molluscum contagiosum on the body - as distinct from the face and neck - is not a sign of HIV infection. Molluscum is a common sexually transmitted disease and causes a typically brief explosion of a rash which then usually disappears promptly in adults.
Your symptoms do not sound like HIV ARS to me - I understand your concern but I think on this occasion it is likely misplaced. I suggest that you take an RNA PCR HIV TEST along with a 4th generation HIV combined antibody and p24 antigen test at 2 weeks after finishing PEP. This will give you a very strong indication as to your status. Internationally agreed standards suggest the need for a final and conclusive HIV test at 4 months afterexposure or three months after completion of PEP to confirm you are HIV negative.
kind regards, Sean
I do think it is unlikely that you will have acquired HIV from the episode you describe and the accepted risk is of the order of 1 in 1667 with the other party being HIV positive. Being circumcised will reduce the transmission rate from HIV+ female to male by a sizeable factor and that might be operative in anal sex as well.
PEP will have reduced the chances of acquisition by a further factor of approx. 80% or so.
It would be very unusual to have ARS signs whilst taking PEP as the whole rationale is to suppress HIV viral activity and thus prevent HIV replication. ARS will depend on replication - no replication = no ARS.
Molluscum contagiosum on the body - as distinct from the face and neck - is not a sign of HIV infection. Molluscum is a common sexually transmitted disease and causes a typically brief explosion of a rash which then usually disappears promptly in adults.
Your symptoms do not sound like HIV ARS to me - I understand your concern but I think on this occasion it is likely misplaced. I suggest that you take an RNA PCR HIV TEST along with a 4th generation HIV combined antibody and p24 antigen test at 2 weeks after finishing PEP. This will give you a very strong indication as to your status. Internationally agreed standards suggest the need for a final and conclusive HIV test at 4 months afterexposure or three months after completion of PEP to confirm you are HIV negative.
kind regards, Sean
Dear Dr. Cummings:
Thank you for your detailed response. I greatly appreciate it. Just one follow-up question: In the event PEP fails to limit HIV replication to a level that the virus is eliminated but still reduces the viral load, is it not entirely plausible to experience low severity/duration ARS symptoms while still on PEP?
Thanks
Thank you for your detailed response. I greatly appreciate it. Just one follow-up question: In the event PEP fails to limit HIV replication to a level that the virus is eliminated but still reduces the viral load, is it not entirely plausible to experience low severity/duration ARS symptoms while still on PEP?
Thanks
Dear doctors, I would greatly appreciate a response. An additional question - do ARS associated rashes "crust"? Half of my 25 odd red bumps appear to have a pinpoint hole in the model which is crusting as they subside others are pimple like. Thanks
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