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Pep
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This forum is limited to prevention of HIV and to safe sex in general. All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Pep

Doc,

A few weeks ago, in a lapse of judgement, i had a 5 minute unprotected intercourse with a CWS from Indonesia that i met in an upscale hotel bar.  Thirty-six hours later, I went to a clinic in Singapore and they prescribed PEP for 30 days.  I am on day 28 and have a few questions.

1.  Given my breif exposure and that she indicated after me getting over the language barrier that she was clean, should i even had been prescribed pep in the first place?

2.  I am on Dexilant and Prevacid, would either one of this medications intefer with the Pep i was taking, the doctor indicated it would be fine?

3.  The doctor prescribed 30 days of PEP, but everywhere i read, one needs to only take it 28 days.  I am on day 28 today, thus is it ok for me to end the treatment?

4.  I read many different opinions about when to test post PEP and what test to take.  If i want an accurate test after 10-14 days, with any test in USA (PCR, DNA...etc), which test should I take?  What would be the range of accuracy on that test?  Further, when is the earliest i can be 100% comfortable with any tests, 4 weeks, 6 weeks, 8 weeks.....and which tests should i take?  There are many test offered online, like this one that says it 99% accurate at 21 days via Lab Corp -HIV-1 DNA by PCR With HIV Antibodies by ICMA Test.  Would this test be a good test at 10-14 days, and is it duo test?  At what time interval would it be conclusive?

Sorry for all of my questions, but i am trying to move on with my life.

Tx
300980_tn?1194933000
Welcome to our Forum.  I'll go straight to your questions:

1.  Given my breif exposure and that she indicated after me getting over the language barrier that she was clean, should i even had been prescribed pep in the first place?

In general, although most people who want PEP can get it is they try hard enough to do so, we do not recommend it unless a person is KNOWN to have been exposed to a partner with HIV.  This is not your case.    I do not know the specific HIV rates among commercial sex workers in Indonesia but I am confident that it is lower than in high prevalence regions such as Sub-Saharan Africa and thus, both on the basis of her statement to you and where she is from, I would not have recommended PEP to you.  As I have already said however, it is a personal decision.

2.  I am on Dexilant and Prevacid, would either one of this medications intefer with the Pep i was taking, the doctor indicated it would be fine?

No, these medications would not have a negative effect on PEP.  

3.  The doctor prescribed 30 days of PEP, but everywhere i read, one needs to only take it 28 days.  I am on day 28 today, thus is it ok for me to end the treatment?

There is little meaningful difference between 28 and 30 days of PEP. Either should be fine and if you decide to stop after 28 days, I would not argue against this decision.

4.  I read many different opinions about when to test post PEP and what test to take.

The standard recommendation for evaluation of PEP is to have a regular HIV antibody test performed at 3 months after completion.  These recommendations do not take into account PCR tests which are not recommended for HIV diagnosis, largely because of increase rates of false positive tests.  A HIV-1 DNA by PCR With HIV Antibodies test is essentially the same or better than a DUO test but again, there is potential for a false positive result.  If such a test is negative a month after completion of PEP I would consider it definitive.  

I hope these comments are helpful. EWH
11 Comments
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Avatar_m_tn
So after day 14 days, would the HIV-1 DNA by PCR with HIV Antibodies provide a > than 50% accurate result?   Further then at day 28, you would consider that exact test definite.  Thank you so much for your time.

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Avatar_m_tn
Also, what is the false postive rate on the PCR test.  Best.
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300980_tn?1194933000
You are asking for data that do not exist- as I said, the PCR test is not recommended for HIV diagnosis and thus there are no systematically obtained data.  Also remember, you are testing for an infection that your risk was very, very low for to start with.

At 14 days, the results are very likely to be true bbut precisely how true cannot be said. The same is true at 28 days, although more so.

The false positive rate for PCR is about 1% which is over 100 times higher than the likelyhood that you have HIV.  EWH
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Avatar_m_tn
However, the duo test such as  HIV-1 DNA by PCR With HIV Antibodies at 28 days will be conculsive.  Sorry, trying to make sure. Thanks!!!
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300980_tn?1194933000
One last time, the recommendations are the recommeendations- they do not include DUO tests or PCR.  Thus, there are NO data and I will not pretend there are.  Nonetheless, your statement is quite likely to be correct. EWH
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Avatar_m_tn
Doc,

I have a few final questions so please bear with me.  I am at 20 days post PEP 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, Given my expsoure was in Indonesia, should i think about getting a PCR/DNA test for HIV-2 or is it extremely rare there?

Second, Dr Hatfield recently mentioned that once a person has a PCR/DNA test at 13 days, for total confirmation at 28 days they need only to get a normal HIV test.  Would that be the same for me, or since i have been on PEP, should i get another DNA test in the next 14 days or so.

Finally, Dr. Hatfield also indicated that for PCR test to be negative at 13 days and exposure was vaginal, then it was one in a million that the final test would be positive.  Is it safe to assume I am in that camp, or would PEP change those odds as well. I have enclosed his quote at the bottom.

Sorry in advance for all the quesitons, and if i have any more i will repay, and post new.

Thanks,


Quote

4,5) You don't say exactly what test you did at 31 days.  If it was an antibody test, the combination of results will be 100% proof you were not infected.  If it was another PCR test, you wasted your money.  Given all the information, including your negative PCR at 13 days, the chance you caught HIV is no higher than 1 in a million, but you need an antibody test to nail it down for sure.

http://www.medhelp.org/posts/HIV---Prevention/HIV-PCR-Test-13-Days-Post-exposure/show/1827725
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Avatar_m_tn
Doc,

Guys, if i need to pay a fee and repost, please let me know.  I have a few final questions so please bear with me.  I am at 20 days post PEP 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, Given my expsoure was in Indonesia, should i think about getting a PCR/DNA test for HIV-2 or is it extremely rare there?

Second, Dr Hatfield recently mentioned that once a person has a PCR/DNA test at 13 days, for total confirmation at 28 days they need only to get a normal HIV test.  Would that be the same for me, or since i have been on PEP, should i get another DNA test in the next 14 days or so.

Finally, Dr. Hatfield also indicated that for PCR test to be negative at 13 days and exposure was vaginal, then it was one in a million that the final test would be positive.  Is it safe to assume I am in that camp, or would PEP change those odds as well. I have enclosed his quote at the bottom.

Sorry in advance for all the quesitons, and if i have any more i will repay, and post new.

Thanks,


Quote

4,5) You don't say exactly what test you did at 31 days.  If it was an antibody test, the combination of results will be 100% proof you were not infected.  If it was another PCR test, you wasted your money.  Given all the information, including your negative PCR at 13 days, the chance you caught HIV is no higher than 1 in a million, but you need an antibody test to nail it down for sure.

http://www.medhelp.org/posts/HIV---Prevention/HIV-PCR-Test-13-Days-Post-exposure/show/1827725
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300980_tn?1194933000
You are splitting hairs and asking for data that do not exist.  You took PEP when it was not inidcated for persons in your situation and now you choose to test at times other than those recommended.  I'll do my best to address your questions but again, please realize thatthere are NO scientific data to answer your questions.

1.  HIV-2 is rare in Indonesia.
2.  What Dr. Handsfield mentioned is for persons who are exposed but, I believe, we do not know about persons on PEP.  A 13 day
PCR is probably sufficient but, as I have said repeatedly, there are no data to guide this other than our expereinces and those of others.  

3.  Hard to follow this question but again, with a negative PCR 13 days following completion of PEP my advice would be to assume that you are in the clear.

EWH
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Avatar_m_tn
Thanks doctor and i am sorry if i was redundant previously.  Should i attempt to get a PCR test for HIV-2 to ease my anxiety, or is it so rare in Indo, that would be a unproductive use of time.  Thanks for all of the advice.
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300980_tn?1194933000
I would not waste my time or money pursuing HIV-2 in any way.  My guess however is that your anxiety will dictate what you choose to do.  EWH
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