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Avatar universal

Testing after 2 days of PEP

Dear Dr. Hook and Dr. Handsfield,

I have been in a panic for about 7 weeks now... I had a drunken night in Thailand and ended up having sex with a Sex Worker on 2/26/14 (first and only time). I know that I used a condom (but not while receiving oral sex). I am not sure, but don't believe condom broke. I remember her touching herself while applying lubricant and shortly thereafter she scratched me with her fingernail on my hand causing me to bleed a bit.

When I came back to the US, the first Dr. I saw put me on PEP on 3/3/14 5 days post exposure (Kaletra 400mg, Zidovudine 300mg and Lamivudine 150mg twice daily.) I took the PEP for 2 days (4 doses) and on 3/5/14 I consulted another Dr. at a UCLA Health clinic who told me that it was crazy that I was on PEP for many reasons. He immediately told me to stop taking the pills. I returned to the doctor a few days later due to very painful lymph nodes in the groin and a single red pimple in my groin region. After he examined me, he said that I was showing signs of LGV (a common STD in Thailand) so he put me on doxycycline for 21 days.

Tests I have taken have all come back Negative:

PCR RNA test at 21 days  (14days after stoping 2 days of PEP)

PCR RNA test again at 33 days (26 days after PEP) 3/31/14

Antibody test at 37 days (30 days after PEP) 4/04/14

Questions:

1. Does the PCR RNA test look for all subtypes of HIV 1 (did it through Labcorp)? Subtype B and CRF A/E are common in Thailand.

2. How conclusive are the PCR tests I took? Percentage of accuracy?

3. Would the 2 days of PEP affect my tests?

4. I know you say 8 weeks is conclusive for the antibody test, but since I was on PEP for 2 days, would I need to extend the test period?

5. What is my overall risk seeing that I may have contracted LGV, but have had negative test results up until now?

I sincerely appreciate your response. Thank you so much in advance! I know I will never make decisions like this again!
5 Responses
300980 tn?1194933000
MEDICAL PROFESSIONAL

Welcome to the Forum.  You characterize yourself as being in a panic and it sounds like that is the case.  You appear to have over reacted throughout the events you describe, taking PEP at the wrong time after a sexual encounter that did not put you at meaningful risk for HIV.  You may or may not  have had LGV but have now been treated for that as well and have repeatedly tested for HIV using tests not recommended for HIV testing.  There is not much else you could do to over react.  Your tests confirm that you did not get HIV from the encounter you describe and would not be affected by your few days of ill-advised PEP.  

Your questions, which I will answer below are typical of the sort we get from panicked persons who allow themselves to be misled by the internet.

1. Does the PCR RNA test look for all subtypes of HIV 1 (did it through Labcorp)? Subtype B and CRF A/E are common in Thailand.

Yes, commercially available PCR tests would detect Thai subtypes of HIV.

2. How conclusive are the PCR tests I took? Percentage of accuracy?

PCR is not recommended for HIV diagnosis because of false positives, not false negatives. Because they are not recommended and are wasteful (there are better tested, cheaper ways to diagnose infection), they have not been carefully studied.  Believe your tests, particularly when considered in combination with your recent antibody tests.

3. Would the 2 days of PEP affect my tests?

No.

4. I know you say 8 weeks is conclusive for the antibody test, but since I was on PEP for 2 days, would I need to extend the test period?.

No

5. What is my overall risk seeing that I may have contracted LGV, but have had negative test results up until now?

Risks become irrelevant when you have properly performed tests.  You are not at risk.  Believe your tests;

EWH
Avatar universal
I have one last question. I had an HPV Vaccine about a week before I took the antibody test. Could this interfere with the test results?
300980 tn?1194933000
MEDICAL PROFESSIONAL
No, the HPV vaccine would have no effect on antibody production.  Believe your test results  EWH
Avatar universal
Thank you so much for answering all of my questions Dr. Hook. I feel much better having heard back from you. Take good care.
300980 tn?1194933000
MEDICAL PROFESSIONAL
I'm glad I could help.  EWH
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