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Avatar universal

ARS Symptoms

Dear Dr. Handsfield: I have high anxiety. No response from Int. Forum (pl. help). 30 days ago I had unprotected insertive anal sex with someone HIV+ (lied about status, condom broke, my utter recklessness). Convinced the person to test next morning. (HIV+, don't no viral load). I was prescribed PEP (Truvada + Isentress) - started apx.12 hours after exposure. Completed the course (except for one 2 hour lapse I took meds on time). I have developed ARS symptoms. I am getting tested soon but need to talk to a professional (I live in a country with no qualified provider, where I face deportation on a +test, aside from family devastation). Reached out to PEP Dr., who cannot help remotely, other than advise to test (antigen and viral load).
Day 26: Day time fatigue, evening abdominal pain, night diarrhea and fever (99.4-101.4F). Took Diloxanide and Metronidazol suspecting a stomach bug.
Day 27: Fever (99.4-100.4F), muscle pain (back and thighs), diarrhea
Day 28: Only diarrhea
Day 29: Rash on back and sides of trunk (looks symmetrical, 20-30 small red raised bumps), half had crusts and pinpoint holes. Dermotolgist diagnosed 2 unrelated rashes: contact dermatitis and molluscum. Said not acute HIV linked (completely discount as he disputed a rash on the trunk can be symptom of ARS). Rash subsiding after 2 days (cream).
Day 30: Large, oval red, tender blister-like lesion on base of toe
I have had all main symptoms: fever, rash, diarrhea, muscle pain, lethargy. Could this be anything other than ARS?
1. Does fever < 2 days too short for ARS or do other symptoms and PEP mean short duration is not material?
2. Would PEP delay (26 days) and reduce severity (short fever/other symptoms) of ARS? I know knowledge is limited but your experience?
3. Abdominal pain common in ARS?
4. Could rash be caused by something else (rash followed fever by 1-2 days but did not overlap)
5. Are PEP failure not so rare?
Thanks
9 Responses
300980 tn?1194929400
MEDICAL PROFESSIONAL
Welcome to the Forum.  As you probably know, Dr. Handsfield and I share the forum and take questions according to our availability.  You got me.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.

The risk for HIV in the exposure you describe is less than 1% before PEP and PEP, when taken properly as you have, reduces risk for infection among exposed persons over 90%.  For you to have developed symptoms while on PEP would be most unusual and the symptoms you describe could well be due to PEP itself.  There are also many other sorts of problems, infectious and otherwise, associated with the sorts of symptoms you report.  If you wish to rule out the possibility that your current symptoms are due to HIV however, you could test at this time with a combination HIV antibody/HIV p24 antigen test.  If your symptoms were due to HIV, the test would be positive.  

As for your specific questions:

1. Does fever < 2 days too short for ARS or do other symptoms and PEP mean short duration is not material?

There are no reliable data on the ARS if a person is taking PEP.  Had you acquired HIV and your symptoms due to HIV, I would expect your symptoms to be more severe than what you report.

2. Would PEP delay (26 days) and reduce severity (short fever/other symptoms) of ARS? I know knowledge is limited but your experience?

Same answer as for 1 above.  I have never had PEP fail in a patient who took their medications.

3. Abdominal pain common in ARS?

No.

4. Could rash be caused by something else (rash followed fever by 1-2 days but did not overlap)

Sure.  your dermatologist has already told you this.

5. Are PEP failure not so rare?
PEP failure is quite uncommon.  

I hope these comments are helpful to you. EWH
Avatar universal
Dear Dr. Hook,
Thank you very much for a quick response. I really appreciate it, your advice and sense of perspective you help restore. While I have layperson knowledge of the percentages, my thinking was if I had indeed acquired the virus from what is an extremely high risk exposure (as sadly many do) then a 90% or so PEP efficacy would still mean c.10 people of out of a 100 in my situation will seroconvert. When I saw the rash follow fever by 48 hours or so I felt I had tested positive. Yourself and Dr. Cummings from the International Forum (who responded) both said that ARS while in PEP would be highly unusual. I had read elsewhere (Body.com) that if PEP fails, then production infection and symptoms would follow immediately - which I took to mean that ARS could happen while still completing PEP.  I suppose it is not possible to answer this question further given the limited knowledge on ARS and PEP. One last question: is MC (on the back) commonly acquired sexually in adults (Dr. Cummings has just informed)? Is 30 days after exposure reasonable incubation period? Would it be normal for it subside in a few days in a healthy immune system? Many thanks
300980 tn?1194929400
MEDICAL PROFESSIONAL
Molluscum is common in adults.  Sometimes as an STI but sometimes through simple, casual contact (it is quite common in non-sexually active children).  The incubation period is not well described but 30 days is reasonable.  EWH
Avatar universal
Thank you.
300980 tn?1194929400
MEDICAL PROFESSIONAL
Glad to help. EWH
Avatar universal
Dear Dr. Hook, fyi I took the ELISA 4th Antigen & Antibody test and the PCR Early Detection Test on Sep 1 (31 days after exposure and 2 days after stoping PEP) and both were negative.  I will take the AB/AN test again in 2-4 weeks from now and then at 3 and 6 months post-exposure. Thanks again.
300980 tn?1194929400
MEDICAL PROFESSIONAL
Thanks for the follow-up.  I don't anticipate that your results will change. Take care. EWH
Avatar universal
Thank you
Avatar universal
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