ARS vs Seroconversion vs HIV PEP

[ekypoo]

I have some questions about HIV transmission, ARS and seroconversion that I was hoping to get some answers on:

First, here's my story, I stupidly had unprotected anal sex (was the receptive partner) without ejaculation (status of partner is unknown). There was no evidence of blood, though microtears almost certainly occur. Anyway, I started PEP therapy with Trizivir 30 hours later. (I'm 18 days into PEP now). I'm not proud of the risk I took and have beat myself up over this repeatedly, but now have to live with many possible outcomes from the poor choice I have made and am trying to educate myself. I know that symptoms are not a reliable indicator of ARS and will not even go down that path (it's amazing how the mind can find evidence of infection when you look for it!). In any case, this was a one time occurence and I had not had sex recently (two months prior was the last), and in fact tested negative very shortly before this all happenned. However, these are the questions I can't seem to get straight answers on:

1. With receptive anal intercourse without ejaculation, I would imagine that the risk is typically lower than with ejaculation because the amount of possible body fluid to be exposed to is less. Also, I believe that typically pre-*** has less HIV in it than semen. Are these statements accurate? I'm well aware that transmission is still possible, but just looking at probablilites here.

2. What is the difference in timing from seroconversion and ARS? Do they happen concurrently? Some places I seem to read that ARS would be before seroconversion, others mention it at the same time. In some instances I have read that ARS would precede seroconversion by 10 days. I've read that both ARS and seroconversion can occur between 2-4 weeks, 2-6 weeks, after 5 days, up to 6 months?  I guess intuitively, I would think that ARS first and then seroconversion.

3. If I do get ARS while on HIV PEP, does PEP tend to delay or minimize the symptoms?

4.  I have been really lucky so far with the Trizivr as the side effects have been relatively minimal (as compared to other stories I've heard).  Mainly muscle aches, some fatigue and stuffy nose and scratchy throat.  I know the stuff is very strong, and was wondering if it is ok to exercise while on it.  I don't want to tax my body which is already processing the Trizivr and potentially fighting infection.

I appreciate any help or response I can get.

[H. Hunter Handsfield, M.D.]

My expertise is primarily in the traditional STDs, not HIV/AIDS except in regard to transmission, prevention, and interactions between HIV and other STDs.  So except for question 1, I really cannot answer you very well.

1) It is logical that transmission risk is lower without ejaculation than with it.  But to my knowledge there are no data either on this point or on the amount of HIV in pre-ejaculate fluid compared with semen.  Therefore, I cannnot venture a guess about how much lower the risk might be (and I doubt anyone else can either).

2) Seroconversion and ARS occur on more or less the same time frame.  My guess is that delayed seroconversion--which is extremely rare anyway--is even more rare in people with symptomatic ARS.  But this is well outside my expertise.

3,4) Sorry, I do not know whether the symptoms are delayed or otherwise changed in ARS occur despite PEP.  As far as I know, there is no reason not to exercise while on Trizivir.

Sorry I can't be more helpful.  Thebody.com is an excellent online resource about HIV/AIDS.  Even better, have you posed these questions to the provider who prescribed PEP?  S/he probably knows more than I do.

Good luck--  HHH, MD

[ekypoo]

Thanks for the reply.  Last question - typically, how soon after infection (let's just assume non-pep for now) would symptoms appear?

[Willl]

I have read normally within the first 4 weeks ARS occurs.

Regarding PEP and testing, it would seem logical to me that if the virus is kept at a low enough level, then your body would not have a reason to mount a full immune response like it would if the virus was allowed to replicate normally. But I don't know, I am not a doctor.

I did find the following:

1) "Circumstances for which extending the duration of follow-up have been suggested include the use of highly potent antiretroviral regimens (i.e., more than two drugs) because of theoretical concerns that HIV seroconversion could be delayed, or simultaneous exposure to HCV"

http://www.medadvocates.org/diagnostics/cdc/hcw_guidelines.html

2) Timeline of infection, you can see when the viral load is highest is around the time ARS occurs, and seroconversion is commonly suggested around this time as well.

http://en.wikipedia.org/wiki/Image:Hiv-timecourse.png


3) Dr. Bob seems to think PEP would not affect antibody testing, only PCR, hopefully he is right.

http://www.thebody.com/Forums/AIDS/SafeSex/Archive/TransmissionSexual/Q165017.html


I hope this will help you some, without misleading.

[G-Man]

I really thought you were an expert in the field of HIV. I know you went to Africa for research on HIV. I know your not taking the place of our own Dr. when it comes to advice on HIV, but why answer such questions if you really are not an expert. You sure kind of hit me where it hurts on this new information. How reliable has your info. really been. Thanks Alot!

[worried in toronto]

Doctor H is an expert on Std's and the epidemiology of HIV if I am correct....

The docs on thebody are immunologists/hiv specialists etc.

[Willl]

Dr. Bob provides a more detailed opinion on PEP here:

http://www.thebody.com/Forums/AIDS/SafeSex/Archive/Treatment/Q165487.html

[wwarrior]

If I'm not mistaken Dr. HHH is an STD epidemiologist, which deals with the incidence, distribution (transmition) and control (including prevention) of STD in the (or a) population.

People that come here want to know if they are or were at risk of exposure of HIV. The above mentioned discipline deals with this (amongst others STD) sort of issue. Dr. HHH has an unquestionable reputation in this field. Feel safe here if what you seek is knowledge on risks of transmition.

Dr. HHH is only been responsible when he declines to abund in  questions of form, structure and treatment of HIV once it is acquired.

If a person wants to know what happens to him/her AFTER he/she acquires HIV, then they need to seek care, advice and treatment with an hematologist or an immunologist.


Take care and good luck