Hi, I am a transwoman who had gender reassignment surgery using the penile inversion method, meaning the surgeon who created my neovagina used penile material. I assume that many community members here are not doctors and/or medical professionals. But I still could use your feedback, support, and knowledge about HIV and PEP. I think it is important for me briefly mentioned my surgical history within the context of my potential HIV risk. I also assume that traditional HIV risk statistics are somewhat out the door in my case because of my gender reassignment history.
On March 3rd, I had vaginal and anal sex for the first time in my life. I had this sex with a guy of unbeknownst HIV status to me. We had used a condom, which I had put on him, but it got in stuck in my neovagina. I don’t know if he ejaculated into me or the condom prior to it getting stuck in me. I took the condom out of me and then we switched to anal sex with a new condom. Fearful of my HIV risk, I tried to go on PEP later that day, but the nearest urgent care center would not proscribe me PEP because I didn't have an occupational risk. The next day, I visited the local LGBTQ community health clinic near me and went on PEP within 24 hours of my potential HIV exposure. I completed the 28-day trial of Truvada and Tivicay on or around April 1st. I was fairly consistent with taking it. Except for occasional headaches, I didn't notice any potential ARS symptoms. Given the COVID-19 situation and being Type I Diabetic, I was unable to go for follow-up appointments at the community clinic. They are no longer seeing patients in person because of the pandemic.
Around May 5, I started feeling lethargic. About seven days later, my throat started to feel slightly sore. I also had slightly swollen lymph nodes and enlarged tonsils. But I had no discernible fever. I am surprised that I developed the sore throat as I have been in quarantine with limited exposure to people, except for my immediate family, because of the COVID-19 pandemic. No one in my family has had a sore throat.
On May 19th, I went to my doctor given that I still had the sore throat and tonsillitis. She conducted strep and mono tests, the results of both of which came back negative. She also ordered a COVID19 test, which also came back negative. During the ensuing weeks since my dr’s appointment, I developed diarrhea attacks and a few aphthous sores on my lips. The aphthous sores are an unusual development for me.
Currently, I still have a sore throat, recurrent aphthous sores on my lips, and tonsillitis. I am very worried and concerned that these and the other symptoms that I experienced might be late onset symptoms of acute HIV delayed because of the PEP.
I have the following questions: Can a person have an onset of ARS symptoms at 8+ weeks since HIV exposure? Can PEP/PREP delay the onset of ARS symptoms/seroconversion? Is Tonsillar Hypertrophy and/or tonsillitis a common ARS symptoms?
Prior to this HIV scare and PEP, I do have a history of consistently elevated liver enzymes. Plus, I am diabetic. My liver enzymes were also high on the tests the community clinic ordered on March 4th. Can being diabetic and having elevated liver enzymes impact the efficacy of PEP/PREP?