hiv pep efficacy and testing

[worried_nosowell]

hi.  before putting on a condom, i had a brief receptive anal experience (3-4 pokes, 10 seconds max). he said he was negative.  i didnt care  - condom on.  but again, not before a little few pokes before.   not good.  i went on pep in <50 hours.  truvada and isentress.   my baseline was negative.  week 2-3 while not sick, was very sluggish and tired.  but no "ARS" symptoms yet.

he told me today he tested positive.  no idea how new, but clearly not on medication.

today was 3.5 weeks, took oraquick and was negative.  not at all conclusive  but a good sign in the right direction.  i also got an RNA test at the doc - which will take a week to get back.  

1.  docs have sent confusing info on if seroconversion is delayed from pep.  i have generally heard that a 3 week is a good sign, a 4 week will be very strong and a 6 and 8 week test is definitive.  even with pep.  ?

2.  i know this was risk.  i know it was stupid.  but how at risk am i?  given that episode and given pep?

3.  at what point in exposure are you infectious to others?

thanks for this.  

[KJ268]

He is a slow progressor so far as it seems. But if he is really at <50 copies/undetectable, your risk was EXTREMELY, EXTREMELT low risk to non-existent.

Studies these days show that an undetectable viral loads bring transmission risk down as close to zero as humanly possible without obtaining the status of "no risk" due to the rarest of rare circumstances.

[worried_nosowell]

He just learned last week.  Is not yet on meds

[KJ268]

It means he may have new and is on medication to treat the virus and it's undetectible at <50 copies OR his body is fighting and keeping the virus at bay and he is a slow progressor.

[worried_nosowell]

ok, this only gets more odd.  the guy who was positive called to tell me his VL is 50 copies...and cd4 is like 800.   HUH?  is it even possible to have a low viral load like that while not taking meds??

remember he didnt know he was positive until a week ago.  even if he became positive in say, feb., i cant imagine his body lowered his VL that much.  do you ?

i asked him if he meant 500 or 5000?  and he said  -no, 50.  

hmmmm.

[KJ268]

No, PEP is to prevent infection and it's not strong enough to surpress infection. If you were infected, which is unlikely again,  and even more unlikely with the PEP, the PEP would barely, if anything, effect your viral load as it is not strong enough and in combination with other meds.

[worried_nosowell]

Hmmm. Ok.  But this reduced viral load. Assumed that meant I was less infectious.

[KJ268]

Not necessarily, no, you wouldn't be any less infectious. If you're positive, you're not infectious. If you're negative, you're not infectious. Unfortuantly, there are no cutting corners.

[worried_nosowell]

Wouldnt I also be less infectious given I am on PEP?  That doesn't mean I would ever do something unsafe.

[KJ268]

Do not be terrified. You did the right thing and took PEP and PEP works: extemely well when taken within 48 hours and very well within 72. It's a difference of like 98% to 95%

[worried_nosowell]

Thanks.  I am terrified

[KJ268]

It's a theoretical risk at best. The only confirmed risk are anal and vaginal unprotected. Giving fellatio is the only form of oral sex that may be a risk that calls into question the level of risk in which it really is. It's very low risk but it's not no risk.

I would not worry for him though. You're still on the right path to coming out of this okay.

[worried_nosowell]

i had oral sex with another partner where i came in his mouth or he swallowed   has me a little concerned.

[KJ268]

Pretty much immediately. Within 2 days definitely but assume immediately. Do NOT have unprotected anal or vaginal with anyone until your 12 week negative. Even then, always use a condom until you're in a fully, understandably monogamous where you both know what that word truly means, have both tested conclusively negative and plan on being partners.

[worried_nosowell]

thanks,  and when are u infectious to others?

[KJ268]

When on PEP, you can not test (not including your baseline when you're administered PEP) until you COMPLETE your full month supply of PEP as prescribed by your physician. Once you complete your dosage of PEP, you can test at 8 weeks post your completion of PEP for a conclusive result although officials guidelines say to test at 6 weeks and then 12 weeks to confirm.

You had a decently high risk exposure: Receptive anal with a confirmed positive although brief. The brief exposure works in your favor but if he was recently infected, he is the most infectious he will probably ever be.

PEP works and works best within 48 hours (which you did)

I expect you to be okay.