HIV Testing After PEP

Hi,

I'm a 38 year old gay guy in Edinburgh, UK who's been going out of his mind with worry for the past seven weeks. On Sat 20th Jan I had anal sex (me receiving) with a casual partner which was unprotected  for some of the time. We were both really drunk, but my recollection is that he didn't actually come before we both flaked out - though I'm not totally certain. I can't believe I did something so stupid - the only other guy who's ever been inside me is my partner of 13 years, and then only ever with condoms.

I got in touch with the guy the next morning and he said he's sure he's HIV negative but hadn't been tested for a while. On the Monday morning I went to my local STD clinic and although they said they didn't think I was high risk, they offered me a course of PEP which I started taking 58 hours after the incident. I completed the whole 30-day course.

Last Tuesday, six and a half weeks after the event, I had my first HIV test which came back negative. I thought it would give me some confort, but I'm still pretty wound up. When I got the test results back I mentioned that I'd read that there seemed to be fairly good evidence that 80-90% of people would show positive by six weeks if they were going to (having been lurking on this site reading postings for a while!). The staff were fairly dismissive and said that it was a good sign, but no where near that conclusive.

I've also seen some suggestion that PEP can delay seroconversion, so you can guess where my mind is going with that one as I wait for the 13 week test! Is delayed seroconversion because of PEP something you've had experience of? Or evidence of people who've tested negative shortly after PEP treatment and positive at a later stage?

Thanks in sdvance for any advice.

[H. Hunter Handsfield, M.D.]

I am not an expert on PEP and cannot answer with certainty whether the treatment might have delayed seroconversion.  It makes sense, but I just don't follow the literature in that area.  The best source of the information you seek is the GUM clinic that prescribed the PEP for you.  Did you ask them?  If you want another opinion as well, you might post your question on one of the forums at thebody.com.

Having said that, since your partner believes he is negative, the odds you were infected obviously are low, and my guess is that you don't have anything to worry about.  In my STD clinic, we would not have offered PEP to a person in your situation; we require documented exposure to a known HIV-infected partner.  For still further reassurance, why not talk to your partner of January 20 and ask him to be retested?  If he still is negative, you definitely are home free.

Good luck--  HHH, MD

[Willl]

I have also read that PEP delays seroconversion on many other non-MD moderated sites. However, the Dr. here has enlightened us recently that such drugs do not delay seroconversion. There may be a research paper available that suggests the possibility for delayed seroconversion on tests with monkeys, but I have neither read the entire paper nor do I know if this paper has been conclusively disproven elsewhere, which is likely the case.

He may recommend another test since yours was a high risk means of transmission, yet you do not know the guy actually has HIV and he says he doesn't. Or he may say the 6 weeks is good enough, seeing that you also took PEP to reduce the likelihood you actually have it even further at this point.

[carnageofthepast]

I read a ton of research after my scare (as I'm sure you have)

The basic information I came up with was that some research suggested that PEP in theory could delay seroconversion, but this was in studies done in healthcare workers.  The studies didnt prove that PEP delayed seroconversion, only prevented seroconversion by about 80% - which is a good thing.  That means your chances of acquiring hiv at this point are miniscule.  You dont know that your partner even had hiv, in the worst case scenario that he did, your chances from a single exposure with PEP would be very low.  Given you've already had a negative test, I'd say you're in clear!  However, I'd get another test at 3months just to be sure.

[carnageofthepast]

Oh and by the way, DONT have unprotected anal sex again!  And dont get drunk when you might be in a situation where casual sex may occur!  Trust me it causes bad things to happen.

[Willl]

I am a little confused. When you said here: http://www.medhelp.org/forums/STD/messages/2577.html

"You are one of many people who seem to believe (or worry) that other illnesses, medications, and so on can prevent accurate HIV testing. Not true."

Were you referring to ALL other medications (or even recreational drugs?) besides PEP?

[Maxxy35]

Thanks for your reply. I did ask the GUM clinic about the impact of PEP on test results and seroconversion but they were pretty non-commital. Their line has always been that the important tests are at 3 months and 6 months, that any earlier test might give a false negative. However because I was so anxious, the 6-week one was supposed to give me some reassurance - which hasn't quite worked out! From what other respondants have said, it looks like while there's no tangible proof that PEP would delay seroconversion, there's no cast-iron guarantee that it wouldn't either.

Unfortunately, getting my partner from 20th Jan to test for HIV doesn't really look like an option - though it's something I'd thought of a few weeks back and I wish that it was! Looks like I'll be continuing the hoping and praying for at least the next 6 weeks. What a fool I am!

M

[Maxxy35]

Carnageofthepast - thanks for your posting and words of reassurance. Not sure exactly what your scare was, but I hope that things have worked out.

I'll definitely be testing again at 3-months - it's already fixed up for 24th April. From the way I feel right now, that seems like a long, long time away!

And I take your point about safe sex and the link between drinking and bad things happening. This was the first time in my 38 years that I've ever slipped up like this and I hope I'm lucky enough not to have to suffer the long-term consequences. Believe me, even if I come out of this with a clean bill of health, this has been one very tough lesson!

M

[H. Hunter Handsfield, M.D.]

Willl:  Yes, I was referring to all drugs.  I am unaware of any data that any drug, recreational or otherwise, has any influence on speed of HIV seroconversion.

Maxxy:  My guess is that there are no systematic studies, and therefore no definitive data, on the influence of PEP on speed of seroconversion.  Hence the noncommittal responses from your GUM providers as well as from me.

HHH, MD

[Jasson]

A related discussion, PEP can delay seroconverion? was started.