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Questions about Pep
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Questions about Pep

Doc,

About 3 weeks ago i was in Jakarta, and picked up a women in a 5-star hotel bar that seemed healthy but definitely from time to time was picking up guys for money.  As we we were very intoxicated, i believe we had unprotected intercourse for about 2-3 minutes and then feel asleep.  Upon waking up in the morning, i asked if she had HIV and she did not understand my question and said yes. But then when i asked here in a clearer fasihon if she had HIV/AIDs she adamantly stated she did not have the disease and was tested about 3 months ago.    About 36 hours post the act, i was in Sinapore and a doctor prescribed PEP and gave me a 30 day supply.  I have the following questions.

1. Given if i had any exposure, and it was brief, should i even been prescribed PEP in the first place?  I believe she did not understand the question at first, and then answered honestly when she understood the question.
2.  The doctor gave me a 30-day supply of PEP, but I understand i only need 28 days, so is it safe to discontinue the program at day 28.
3.  When is the soonest i can get an HIV test and be certain i am not postive?  I plan on taking a Lab Corp duo HIV-DNA test/Normal HIV test offered online at 14 days, is that enough time to get an accurate result? I am under the belief that the duo test at 28 days should be 100% conclusive?  I have read from time to time that Doctors recommend waiting 3 months afte PEP, but that is in cases where the DNA test is not available.
4.  What are the odds, from this act, combined with the PEP of me actually contracting the virus.

I am deeply concerned about this and want to move on one way or another.  I appreciate you answering my questions, and you guys provide a great service.

Tx  
1024580_tn?1331577721
Hello,
Thank you very much for yout post and welcome to our forum.
I will try to answer each of your questions here below:
1.) I would have recommended PEP if we knew that the lady was definitely HIV positive.  Not knowing her status but being from a high prevalence group (sex worker), PEP can be considered and would have been open for discussion.  The estimated risk to you, if she was positive, is estimated at less than 0.1%.
2.) There are different regimes of PEP.  Most are prescribed for 28 days.  I would suggest that you follow the advice of the doctor who prescribed it.
3.) Current UK guidlines would only consider as fully conclusive an antibody test after 12 weeks of finishing PEP.  However in practical terms, a negative Duo test after 4-6 weeksis highly reliable and can be ocnsidered conclusive.  A negative PCR test after 10 days of finishing PEP is highly reassuring, but not conclusive.
4.) I beleive that very negligible, close to zero.  Your initial risk was low, and you have taken PEP.  I am confident that you are absolutely fine.

The Duo test detects the HIV antibodies, together with the p24 antigen.
Kind regards,
Dr José
5 Comments
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Avatar_n_tn
I am confused about the type of tests i should take now that i am back in the USA.  Is the HIV-1 DNA by PCR With HIV Antibodies by ICMA Test offered by labcorp in the USA, an appropriate early dectition test or is an PCR RNA test a better more accurate test.  If so, how do the tests differ in accuracy? Also, the Duo test that is commonly discussed, what exactly is it, and is the HIV-1 DNA by PCR With HIV Antibodies by ICMA Test a Duo Test?  If it is not a duo test, then what is one that i can take in the USA?  I already asked about the timing on when to take these tests above, but i want to make sure i follow the correct steps exactly so any further color on that would be appreciated.  Thank you for your time.  
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Doctor,

Doc,

I have a few final questions so please bear with me.  I am at 20 days post taking my PEP regime and took theLab Corp -HIV-1 DNA by PCR With HIV Antibodies by ICMA Test and the results were as follows:

Test                                Value                     Range                       Result Test  
HIV-1 Antibody              <1.00                    <1.00                         Negative  
HIV 1/O/2 Abs, Qual      Non Reactive       Non Reactive            Negative  
HIV-1 DNA                     Negative -                                                Negative

First, I read about the Duo test at 28 days being conclusive, but do not really understand how exactly that test is defined here in the USA?  I know the test above is a PCR/DNA test, but would it also be consider a duo test?

Second,  Given it is day 20, not day 28 is it true that the odds are about 90% in my favor that i am negative?

Finally, should i get retested with the same type of test above in the next two weeks to ensure i no longer need any testing and can consider that test conclusive?  If not, is there another type of Duo/other test i should look for in the USA.  

I really appreciate your time as you guys provide an invaluable service.    
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1024580_tn?1331577721
I do not know about the USA.  You would need to consult with a doctor there.  
Your negative test results are highly reassuring and a very good sign, but they are not considered conclusive.  None of those tests are the Duo or Combo test, which needs to also test for the p24 antigen.
Current UK guidlines would consider the tests that you had to be final and conclusive only after 12 weeks of finishing PEP.  However a negative Duo test can be consider conclusive after 4-6 weeks of finishing PEP.
Best wishes,
Dr José
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Avatar_n_tn
can u please tell me what the duo test is exactly so i can search for it here. Also, i understand the PCR-DNA test is more accurate or equivalent to the PCR-RNA test, is that accuarte. tx
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